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Adjudication committee
- First opponent: Medical Doctor Fabrice Lecuru, Gynecologic Oncology department, Georges Pompidou European Hospital, Paris
- Second opponent: Senior Consultant Kathrine Woie, Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen
- Third member of the adjudication committee: Professor Kjersti Flatmark, Faculty of medicine, University of Oslo
Chair of the Defence
Professor II Anne Flem Jakobsen, Faculty of Medicine, University of Oslo
Summary
Endometrial carcinoma (EC) is the most common cancer of the female genital tract in industrialized countries. It is well accepted that surgical staging of EC should include removing the uterus, tubes and ovaries, but the role and extent of lymph node dissection is highly debated. Sentinel lymph node (SLN) biopsy has emerged as a reasonable approach compared to lymphadenectomy (LND). Although the SLN technique and algorithm have evolved over the past few decades, there remain unanswered questions regarding the role of SLN biopsy in the management of EC.
The main aim of this thesis was to investigate the introduction of indocyanine green (ICG) as a novel dye in the detection of SLNs. To evaluate detection of metastatic nodes and oncologic outcome, comparing an SLN approach to lymphadenectomy, and to investigate treatment patterns and oncologic outcome of patients with low-volume metastasis. The investigations were based on retrospective data from the Memorial Sloan Kettering Cancer Center institutional SLN database in addition to a historic LND cohort from the Mayo Clinic, Minnesota.
We found that ICG was superior to blue dye in detection of SLNs. Importantly, ICG was superior to blue dye in obese patients. We also found that the detection of nodal metastasis is not compromised by applying an SLN algorithm, compared to a lymphadenectomy, with similar oncologic outcomes.
EC patients with low-volume metastasis had similar oncologic outcomes as node-negative patients, and improved oncologic outcomes compared to patients with nodal macrometastasis. We cannot yet determine whether improved outcomes for patients with low-volume metastasis is due to receiving adjuvant therapy or to the fact that this group may have a more benign course inherently.
Overall, the SLN algorithm is accurate in detection of nodal metastasis in women with early-stage EC, and does not appear to compromise oncologic outcomes within this short follow-up.
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