A Feasibility Study Of The Role Of Sentinel Lymph Node Detection In The Management Of Patients With Apparent Early Stage Endometrial Cancer

The intra-cervical injection technique using radio-colloid and Patent Blue dye will be used for SLN mapping. The radio-colloid injection will be carried out on the day of the procedure and pre-operative lymphoscintigraphy with SPECT-CT will be obtained. Patients who have consented to the trial will be brought to the Nuclear Medicine Department at Royal Melbourne Hospital on the day of their planned surgery. In a similar manner to performing a pap smear, the cervix will be injected with 2mls of the radiocolloid, Technetium 99 at the 12, 3, 6 and 9 o’clock position. After the speculum is removed the patients will be asked to complete a Visual Analogue Score to assess pain related to the injection. The SPECT-CT will then be performed to track the route and nodal uptake of the radiocolloid and this information will be returned with the patient to the operating theatre. Under general anaesthetic after initial inspection of the peritoneal cavity, a gamma probe will be used to locate any hot nodes (at least 10 x the background activity). Two millilitres of Patent Blue dye will be injected into the cervix at the 3 and 9 o’clock positions. The SLN biopsy will be carried out prior to the hysterectomy and any nodes which are hot, blue, or both hot and blue will be removed and be set aside for separate histological examination. Hot nodes will be confirmed ex vivo (by counting activity for 3 to 10 seconds) and the nodal basins will be checked for any further nodes. All identified sentinel nodes will be removed and their location noted. Women with presumed low risk disease will undergo a hysterectomy and bilateral salpingo-oophorectomy and only SLN identified at the time of the procedure will be removed.