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Comment & Response
May 5, 2021

Sentinel Lymph Node Concept in High–Risk Profile Endometrial Cancer—Reply

Author Affiliations
  • 1Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada
  • 2Division of Gynecologic Oncology, University Health Network/Sinai Health Systems, Toronto, Ontario, Canada
JAMA Surg. 2021;156(8):799-800. doi:10.1001/jamasurg.2021.1470

In Reply All prospective studies of sentinel lymph node (SLN) biopsy in endometrial cancer published to date have made valuable contributions to the literature because each has evaluated the diagnostic accuracy of SLN biopsy in a specific patient population of interest. The Sentinel Lymph Node Biopsy vs Lymphadenectomy for Intermediate- and High-Grade Endometrial Cancer Staging (SENTOR) study1 enrolled a uniform but pragmatic population of women with high-grade histology on endometrial biopsy and strictly clinical stage I disease (ie, no cervical/extrauterine disease on physical examination, preoperative imaging, or intraoperative survey). In contrast, the Pelvic Sentinel Lymph Node Detection in High-Risk Endometrial Cancer (SHREC)2 study enrolled patients with either clinical stage I or stage II disease and at least 1 of the following high-risk features on endometrial biopsy or expert preoperative imaging: high-grade histology, 50% or more myometrial invasion, or cervical stromal invasion. Therefore, the SHREC study2 enrolled a large number of patients with low-grade histology. While high-risk criteria such as depth of invasion may indeed help identify patients with low-grade histology who require nodal assessment, this was not the underlying question evaluated in the SENTOR study. We evaluated a different patient population and maintain that the SENTOR study presents new and useful data.

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