1. Pericervical injection of 99mTc-Nanocolloid IS superior to peritumoral injection for sentinel lymph node detection in SPECT/CT
Dr. Martin Weiss
Department for womens health Tübingen

2. Actual german recommendations for endometrial cancer therapy
pT1a and G1/G2
No LNE
If macrosopically cN(-)
≥ pT1b or G3
Systematic pelvic and para-aortic LNE
Latest access:

3. Benefit of pelvic and paraaortic LNE in case of endometrial cancer FIGO I
Systematic lymphadenectomy
Increased Morbidity
ASTEC study group, Kitchener H et al. (2009):
- “Pelvic lymphadenectomy cannot be recommended as routine procedure”
Benedetti-Panici et al. (2009)
- „Systematic LNE did not improve disease-free or overall survival”
May et al. (2010)
- No benefit of systematic LNE
Todo et al. (2010)
- OS significantly longer in intermediate and high risk carcinomas
- No increase of OS in low risk carcinomas
Compromise between systematic LNE and Non-LNE

4. Benefit of pelvic and paraaortic LNE in case of endometrial cancer FIGO I
Ballester et al. (2011, Senti-ENDO)
- „SLN biopsy upstaged 10% of patients with low-risk”
Lurain et al. (1991)
LN metastasis  5Y disease free survival drops from 90% to 54%
Most important prognostic factor
LN metastasis in FIGO Ia: 5%
 Need for adequate staging!
but..
Compromise between systematic LNE and Non-LNE

5. Tübingen treatment algorithm for endometrial cancer
AE bilateral
Maximal tumor resection pelvic LNE
paraaortic LNE
Maximal tumor resection / Exenteration
Laparoscopic
Hysterectomy
Abdominal
Hyster-ectomy +
Extrafascial hysterectomy
pelvic SLNE
pelvic (S) LNE
paraaortic LNE
pelvic (S) LNE
paraaortic LNE

6. Different approaches of sentinel lymphnode labeling
Established methods
Experimental methods
Pericervical injection
Hysteroscopic peritumoral injection
Fundal peritumoral injection
Transvaginal ultrasound–guided myometrial radiotracer injection
Transcervical subepithelial injection into the isthmocervical region of the myometrium
Brucker et al. 2014
Torné et al. 2013

7. Sentinel Lymph Node Detection of Endometrial Cancer in SPECT/CT: Tübingen trial design
Patients randomised
Pericervical Tc-injection
3-, 6-, 9-, 12-o‘clock
Peritumoral Tc-injection
4 sites
(hysteroscopy)
Pre-operative
SPECT/CT image acquisition at > 3 h p.i.
Sentinel lymph node identification by handheld γ-probe
surgery
Histopathological examination

8. Sentinel Lymph Node Detection of Endometrial Cancer in SPECT/CT: Tübingen trial results
Sahbai S, Taran FA, [..], Wallwiener D, [..] Brucker SY et al. 2016

9. Pericervical injection of 99mTc-Nanocolloid for sentinel lymph node detection in SPECT/CT
Peritumoral injection
Enhanced SLN detection
Enhanced detecion of bilateral pelvic SLN
Enhanced detection of macro-metastases
Low invasiveness
Better detection of paraaortic SLN
More invasive, general anasthesia
SLN detection in pT1a endometrial cancer
Accurate staging and prognosis assessment.
Pericervical injection of 99mTc-Nanocolloid and SPECT/CT
Simplified and the less invasive injection procedure.
Higher sentinel lymphnode detection rate. Improved accuracy of sentinel lymphnode mapping.

10. Modern Gyneco(onco)logy
Minimisation of surgical trauma
Maximum of oncological safety
Optimized staging and therapy
Reliable prognostic parameters
Individualised and best fitting therapy concepts

11. Acknowledgements Herr Prof. Dr. Diethelm Wallwiener
Frau Prof. Dr. Sara Brucker
Herr Prof. Dr. Andrei Taran