Assessing para-aortic nodal status in high-grade endometrial cancer patients with negative pelvic sentinel lymph node biopsy

Sep 21, 2026

Objective: Determine the accuracy of pelvic sentinel lymph node biopsy (SLN) for detecting positive para-aortic (PA) lymph nodes in high-grade uterine cancer, and evaluate recurrence rates in high-grade uterine cancer patients with negative pelvic SLNs who did not receive adjuvant chemotherapy. Methods: Retrospective cohort of newly diagnosed high-grade endometrial cancer patients undergoing surgery from 2015–2020, with pelvic SLNs with or without PA dissection; demographics, pathology, and outcomes analyzed using descriptive and survival statistics.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Introduction

Background and rationale

Materials and Methods

Study design and cohort

Results

Patient characteristics and nodal findings

Recurrence and survival outcomes

Conclusion

Clinical implications for adjuvant decisions

DOI: 10. 1002/ijgo.15937 C L I N I CA L A RT I C L E Gy n ec olog y Assessing para-aortic nodal status in high-grade endometrial cancer patients with negative pelvic sentinel lymph node biopsy Anouk Benseler1 | Danielle Vicus1,2 | Allan Covens1,2 | Rachel Kupets1,2 | Carlos Parra-Herran3 | Lilian T. Gien1,2 1Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada 2Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada 3 Department of Anatomic Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA Correspondence Lilian T. Gien, Odette Cancer Center, Sunnybrook Health Sciences Centre, 2075 Bayview Ave. , Room T2 055, Toronto M4N 3M5, ON, Canada. Email: [lilian.gien@sunnybrook.ca](lilian.gien@sunnybrook.ca) Abstract Objective: To determine the accuracy of pelvic sentinel lymph node biopsy (SLN) in detecting positive para-aortic (PA) lymph nodes in high-grade uterine cancer, and to determine the recurrence rate in patients with high-grade uterine cancers who did not receive adjuvant chemotherapy based on negative pelvic SLNs. Methods: This was a retrospective cohort study of patients with newly diagnosed, high-grade endometrial cancer who underwent surgery, including pelvic SLNs with or without PA node dissection, at a tertiary care institution between 2015 and 2020. Baseline demographics, surgical management, pathology data, and outcomes were analyzed using descriptive statistics, and survival analysis. Results: Postoperative histology of the 110 patients meeting inclusion criteria was 45. 5% grade 3 endometrioid, 36.4% serous, 10.9% clear cell, and 7. 3% carcinosarcoma. On final pathology, 63.7% were stage 1, and 23. 6% were stage 3C with positive nodes. A total of 63 patients (57. 3%) had a PA lymph node dissection (56 bilateral, 7 unilateral) in addition to the pelvic SLN. Among this group, 5. 8%(95% confidence interval 1. 2%–16 .0%) had a positive PA node despite a negative pelvic SLN. Among those with a negative pelvic SLN and no adjuvant chemotherapy (n = 75), the rate of distant recurrence was 14.7%, and 3-year recurrence-free survival was 71.9% . Conclusion: The rate of isolated PA node metastasis in high-grade endometrial cancers despite a negative pelvic SLN may be significantly higher than the accepted rate of isolated PA node metastasis in low-grade endometrial cancer. This supports adjuvant treatment decisions continuing to incorporate primary tumor pathology and molecular classification. K E Y WO R D S endometrial cancer, lymph node assessment, sentinel lymph node biopsy, surgical staging, uterine cancer This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2024 The Author(s) . International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics. [1258](1258 | wileyonlinelibrary.com/journal/ijgo)[ |](1258 | wileyonlinelibrary.com/journal/ijgo)[ wileyonlinelibrary.com/journal/ijgo](1258 | wileyonlinelibrary.com/journal/ijgo) Int J Gynecol Obstet. 2025;168:1258–1263 . 1 | INTRODUCTION Sentinel lymph node (SLN) biopsy has become the standard of care for staging low-risk uterine cancer.1,2 However, for high-risk histology uterine cancers, including grade 3 endometrioid, serous, clear cell, and carcinosarcoma, literature reviews and meta-analysis continue to advocate for further research to delineate its utility in terms of both accurate staging and clinical utility to direct adjuvant care.1–3 Pelvic SLN accuracy has been well addressed, with numerous studies performing pelvic SLN and pelvic lymph node dissection in high-risk uterine cancers,4–7; however, isolated para-aortic nodes have been not

FAQs

What was the primary objective of the study?

To determine how accurately pelvic sentinel lymph node biopsy identifies positive para-aortic nodes in high-grade uterine cancer, and to assess recurrence in patients with negative pelvic SLNs who did not receive adjuvant chemotherapy.

How was the study conducted?

It was a retrospective cohort study of newly diagnosed high-grade endometrial cancer patients treated at a tertiary care institution between 2015 and 2020, analyzing demographics, pathology, and outcomes using descriptive statistics and survival analysis.

What did the results show about para-aortic metastasis after negative pelvic SLN?

Among patients who had para-aortic dissection in addition to pelvic SLN, a subset showed positive para-aortic nodes despite negative pelvic SLNs, and distant recurrence was observed in the group without adjuvant chemotherapy.

Sep 21, 2026

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