GANGLIO CENTINELA EN

CANCER DE ENDOMETRIO
Dr. Jairo Mendoza Quevedo
Ginecologa Oncolgica
Ciruga Endoscpica Ginecolgica
FUCS Hospital de San Jos
Clnica del Country.
1. NO TENGO NINGUN TIPO DE CONFLICTO DE
INTERES

2. TAMPOCO RECIBO HONORARIOS DE LA

INDUSTRIA FARMACEUTICA O DE UN
TERCERO POR LA PRESENTACION DE LA
MISMA.

3. MI UNICO INTERE ES DE TIPO ACADEMICO.

 EPIDEMIOLOGIA

5
5

http://globocan.iarc.fr/Pages/fact_sheets_population.aspx
EPIDEMIOLOGIA
 EPIDEMIOLOGIA

SOBREVIDA GLOBAL A 5 AOS

 EPIDEMIOLOGIA

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin 2017 67:7-30..
 EPIDEMIOLOGIA

Chan JK, Sherman AE, Kapp DS. Influence of gynecologic oncologist on the suvival patients with endometrial cancer.
J Clin Oncol 2011; 29: 832-838
 TIPO I

Representa el 80%
Estrgeno dependiente
Tumor endometrioide de bajo grado asociado
a hiperplasia endometrial atpica.

Kurman RJ, Kaminski PF, Norris HJ. The behavior of endometrial hyperplasia: a long-term study of untreated hyperplasia in 170 patients.
Cancer. 1985;56:403412.
 TIPO I

Factores de riesgo: (estrgenos endgenos)

Obesidad
Nuliparidad
Ciclos anovulatorios
Tumores productores de estrgenos
Menarquia temprana
Menopausia tarda

Sherman ME, Sturgeon S, Brinton L, et al. Endometrial cancer chemoprevention: implications of diverse pathways of carcinogenesis. J Cell
Biochem Suppl 1995;23:1604.
 TIPO II

No estrgeno dependientes
Asocian con tumores de alto grado
Mujeres afectadas difieren del las del tipo I
Multparas y mayores

Kurman RJ, Kaminski PF, Norris HJ. The behavior of endometrial hyperplasia: a long-term study of untreated hyperplasia in 170 patients.
Cancer. 1985;56:403412.
 DIAGNOSTICO

70% Dx en EC I
11% Dx en EC II
11% Dx en EC III
3% Dx en EC IV

Schmandt RE, Iglesias DA, Co NN, et al. Understanding obesity and endometrial cancer risk: opportunities for prevention. Am J Obstet Gynecol
2011;205(6): 51825.
 ESTADIFICACIN
QUIRURGICA

Lavado plvico
HAT + SOB
Linfadenectoma plvica y/o para-aortica
Biopsia de reas sospechosas

Benedet JL, Bender H, Jones H 3rd. FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO
Committee on Gynecologic Oncology. Int J Gynaecol Obstet 2000 Aug;70(2):209-62
 COMPROMISO
GANGLIONAR

Alto grado histolgico

Invasin miometrial >50%
Dimetro tumoral >2cm
Compromiso cervical
Compromiso linfovascular
Enfermedad extrauterina
 GOG
33

ESTUDIO PROSPECTIVO
1977 -1983
43 HOSPITALES EN EUA
1,180 PXS
621 PXS ETAPA I
HTA + SOB + LP/LPA SELECTIVA
LABORATORIO CENTRAL DE PATOLOGIA
W. T. Creasman,C.P.Morrow, B.N. Bundy,H.D.Homesley, J.E. Graham, and P. B. Heller, Surgical pathologic spread patterns of endometrial
cancer. A gynecologic oncology group study, Cncer, vol. 60, supplement 8, pp. 20352041, 1987.
 GOG
33

Grado 3 + invasion profunda: 34% pelvicos

Grado 3 + invasion profunda: 23% paraaorticos

W. T. Creasman,C.P.Morrow, B.N. Bundy,H.D.Homesley, J.E. Graham, and P. B. Heller, Surgical pathologic spread patterns of endometrial
cancer. A gynecologic oncology group study, Cncer, vol. 60, supplement 8, pp. 20352041, 1987.
 GOG
33

W. T. Creasman,C.P.Morrow, B.N. Bundy,H.D.Homesley, J.E. Graham, and P. B. Heller, Surgical pathologic spread patterns of endometrial
cancer. A gynecologic oncology group study, Cncer, vol. 60, supplement 8, pp. 20352041, 1987.
CENTINELA

1960

1977
 APLICABILIDAD

Inyeccin de tinte azul (azul de isocyanide, azul patente)

[Echt et al. South.Med.J.1999, O`Boyle et al. Gynecol. Oncol. 2000]
Acercamiento laparoscpico
[Dargent et al. Gynecol. Oncol. 2000]
Deteccion isotopica usando una sonda endoscopica
[Verheijen. et al. Obstet. Gynecol. 2000]
Tcnica combinada
[Malur et al. Gynecol. Oncol. 2001]
Complemento con PET-CT
[Martinez et al. Gynecol. Oncol 2011]
Fluorecencia cercana al infrarojo con verde de indocyanina
[Crane 2010, Furakawa 2010, Boggess 2011]
FIGO 2009
 FIGO 2009

Nueva seccion para mapeo con ganglio

centinela

Enfermedad confinada al utero

Compromiso ganglionar
 ESTADIFICACION QX

Se asocia con riesgo de:

Linfedema
Linfoquistes
Celulitis
Dao a nervios cercanos
LINFADENECTOMIA
10%
 CRITERIOS DE MAYO PARA LA OMISION DE LINFADENECTOMIA EN EL
MANEJO QUIRRGICO DEL CNCER ENDOMETRIAL

LA LINFADENECTOMA DEBER OMITIRSE EN AUSENCIA DE ENFERMEDAD

EXTRAUTERINA Y:
(1) TIPO HISTOLGICO ENDOMETRIOIDE GRADO 1 2, INVASIN MIOMETRIAL
< 50%, TAMAO TUMORAL < 2CM
(2) INVASIN ENDOMETRIAL CON AUSENCIA DE INVASIN MIOMETRIAL
INDEPENDIENTEMENTE DEL GRADO Y DEL TAMAO TUMORAL.
 CENTINELA

Alta tasa de deteccion

Alta sensibilidad

Bajos falsos negativos

CENTINELA
ULTRAESTADIAJE
J.N. Barlin et al. / Gynecologic Oncology 125 (2012) 531535
 Macrometastasis (>2mm)

Micrometastasis (0,2 - 2mm)

Celulas tumorales aisladas (<o,2mm)

J.N. Barlin et al. / Gynecologic Oncology 125 (2012) 531535

 Sensibilidad se increment 85.1% a 98.1%
Valor predictivo negativo increment de 98.1% a 99.8%

J.N. Barlin et al. / Gynecologic Oncology 125 (2012) 531535

C.H. Kim, R.A. Soslow, K.J. Park, E.L. Barber, F. Khoury-Collado, J.N. Barlin, et al., Pathologic ultrastaging improves micrometastasis detection
in sentinel lymph nodes during endometrial cancer staging, Int. J. Gynecol. Cancer 23 (2013) 964970.
- R.W. Holloway et al. / Gynecologic Oncology 146 (2017) 405415
 SLN Vs LINFA

89%
Ballester M, Dubernard G, Lcuru F. Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer: a
prospective multicentre study (SENTI-ENDO).Lancet Oncol. 2011 May;12(5):469-76.
 SLN Vs LINFA

Dara E, Dubernard G, Bats AS. Sentinel node biopsy for the management of early stage endometrial cancer: Long-term results of the SENTI-
ENDO study. Gynecologic Oncology, Volume 136, Issue 1, January 2015, Pages 54-59
 SLN Vs LINFA

10%

E. Raimond,M. Ballester, D. Hudry, S. Bendifallah, E. Darai, O. Graesslin, et al., Impact of sentinel lymph node biopsy on the therapeutic
management of early-stage endometrial cancer: results of a retrospective multicenter study, Gynecol. Oncol. 133 (2014) 506511.
Comparison of a sentinel lymph node and a selective lymphadenectomy algorithm in patients with endometrioid endometrial carcinoma and
limited myometrial invasion. A.G. Zahl Eriksson, J. Ducie, N. Ali, M.E. McGree, A.L. Weaver, G. Bogani. Gynecol. Oncol. 140 (2016) 394399.
 4,3%
P.T. Soliman et al. / Gynecologic Oncology 146 (2017) 234239
 23 Vs 23.3
meses

Survival of patients with uterine carcinosarcoma undergoing sentinel lymph node mapping, M.B. Schiavone, O. Zivanovic, Q. Zhou, M.M.
Leitao Jr., D.A. Levine, R.A. Soslow Ann. Surg. Oncol. 23 (2016) 196202.
 83% 91%

Sentinel lymph node mapping in endometrial cancer: a systematic review and meta-analysis.Lin H, Ding Z, Zhang X. Oncotarget 2017 Jul
11;8(28):46601-46610
Sentinel lymph node mapping in endometrial cancer: a systematic review and meta-analysis.Lin H, Ding Z, Zhang X. Oncotarget 2017 Jul
11;8(28):46601-46610
 CONCLUSIONES

El algoritmo de centinela tiene tasas de falsos

negativos de <5%
Adenocarcinomas grado 1 o 2
Deteccion global de metastasis Vs linfa
Buena sensibilidad en metastasis plvicas
Ultraestadiaje y enfermedad de bajo volumen
Algoritmo centinela en alto riesgo es posible
GRACIAS..!!!