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The Sentinel Lymph Node Biopsy in High Risk Endometrial Carcinoma

Yıl 2021, Cilt: 22 Sayı: 1, 1 - 8, 22.03.2021

Öz

 Endometrial cancer is the most common cancer of the female genital system in developed countries, leading gynecological cancers and ranks seventh in cancer-related deaths. Endometrial cancer is classified into two different clinicopathological subtypes, type 1 and 2. The presence of type 2 cancer indicates a tumor behavior that is prone to metastasis in the early period, it tends to spread rapidly to peritoneal surfaces via the trans tubal route, and retroperitoneal lymph nodes via the lymphatic route. There are some studies reporting that the rate of nodal spread is up to 40% in type 2 cancer. Type 2 cancer is consisted of poorly differentiated tumor histologically and the prognosis is poor also. Two-thirds of patients with type 2 cancer have a disease that has spread beyond the uterus at the time of diagnosis. Tumors with the following characteristics are included in the group defined as high-risk endometrial cancer; Stage I, Grade 3 endometrioid histology, depth of myometrial invasion> 50%, independent of lymphovascular space invasion (LVSI). Stage I, Nonendometrioid histologies (serous, clear cell, undifferentiated type and carcinosarcoma) Stage II endometrial cancer (independent of histological type). Many international gynecological oncology guidelines (ESGO, NCCN), and guideline of Turkish Gynecological Oncology Association recommend a complete staging surgery including hysterectomy + bilateral salpingooferectomy (BSO) + omentectomy + pelvic and para-aortic lymphadenectomy for patients with highrisk endometrial cancer. However, systematic lymphadenectomy not only prolongs the operation time, but also may set stage for operative complications such as severe bleeding, and may cause increased morbidity in the post-operative period such as lymphocyst formation, lymphedema development. Accordingly, the concept of sentinel lymph node Mapping (SLNM) refers to an innovative and minimalist surgical approach that has been put forward to reduce both complications and morbidity. SLNM has been evaluated in many original studies on endometrial cancer in the last decade, its effectiveness has  been investigated in many meta-analysis, and it is now included in the above-mentioned international guidelines. However, in the review of literature, it is striking that SLNM is frequently studied on low and medium risk endometrial cancer. There are a limited number of studies conducted with the high risk  endometrial cancer. Since it is less common, the prognosis is poor and the number of cases suitable for SLNM is limited, high risk endometrial cancer has been the subject of few studies. If the latest version of the guideline of uterine cancers published on the website of the American National Comprehensive Cancer Data Network (NCCN) was reviewed, it concluded as ‘recent evidence indicates that SLN mapping may also be used in high risk histologies ie, serous carcinoma, clear cell carcinoma, carcinosarcoma’. In this review, the current literature on the subject has been reviewed and evaluated considering the results of highlighted studies.

Proje Numarası

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Kaynakça

  • Referans1. Pecorelli S, ed. FIGO Annual Report, years 1996–98. Int J Gynecol Obstet 2003;83:95.
  • Referans2. Brinton LA, Felix AS, McMeekin DS, et al. Etiologic heterogeneity in endometrial cancer: Evidence from a Gynecologic Oncology Group trial. Gynecol Oncol. 2013;129:277–284.
  • Referans3. Creasman WT, Odicino F, Mausinneuve P, et al. Carcinoma of the corpus uteri. FIGO Annual Report, Vol 26. Int J Gynaecol Obstet. 2006;95(suppl 1):S105–S143.
  • Referans4. Cibula D, Ooonk MH, Abu Rustum NR. Sentinel lymph node biopsy in the management of gynecologic cancer. Curr Opin Obstet Gynecol 2015;27:66-72.
  • Referans5. Nicoletta Colombo, Carien Creutzberg, Frederic Amant, et al. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer. Int J Gynecol Cancer 2016;26: 2-30.
  • Referans6. Türk Jinekolojik Onkoloji Derneği (TRSGO) jinekolojik kanserler yönetim kılavuzu el kitabı 2018.
  • Referans7. Volpi L, Sozzi G, Capozzi VA, Ricco' M, Merisio C, Di Serio M, Chiantera V, Berretta R. Long term complications following pelvic and paraortic lymphadenectomy for endometrial cancer, incidence and potential risk factors: a single institution experience. Int J Gynecol Cancer. 2019 Feb;29(2):312-319.
  • Referans8. Lheureux S, Oza AM (2016) Endometrial cancer-targeted therapies myth or reality? Review of current targeted treatments. Eur J Cancer 59:99–108.
  • Referans9. Kitchener H , Swart AM , Qian Q , Amos C , Parmar MK . Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): A randomised study. Lancet. 2009;373:125–36.
  • Referans10. Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, Scambia G, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. Journal of the National Cancer Institute. 2008; 100(23):1707–16.
  • Referans11. NCCN clinical practice guidelines in oncology (NCCN Guidelines), uterine neoplasms, version2.2020 (24 july 2020), www.nccn.org.
  • Referans12. Buda A, Crivellaro C, Elisei F, Di Martino G, Guerra L, De Ponti E, Cuzzocrea M, Giuliani D, Sina F, Magni S, Landoni C, Milani R. Impact of Indocyanine Green for Sentinel Lymph Node Mapping in Early Stage Endometrial and Cervical Cancer: Comparison with Conventional Radiotracer (99m)Tc and/or Blue Dye. Ann Surg Oncol. 2016 Jul;23(7):2183-91.
  • Referans13. Abdelazim IA, Abu-Faza M, Zhurabekova G, Shikanova S, Karimova B, Sarsembayev M, Starchenko T, Mukhambetalyeva G. Sentinel Lymph Nodes in Endometrial Cancer Update 2018. Gynecol Minim Invasive Ther. 2019 Aug 29;8(3):94-100.
  • Referans14. Robert W. Holloway, Nadeem R. Abu-Rustum, Floor J. Backes, John F. Boggess, Walter H. Gotlieb, et. al. Sentinel Lymph Node Mapping and Staging in Endometrial Cancer: A Society of Gynecologic Oncology Literature Review with Consensus Recommendations. Gynecol Oncol. 2017 August ; 146(2): 405–415.
  • Referans15. Pamela T. Soliman, Shannon N. Westin, Shayan Dioun, Charlotte C. Sun, Elizabeth Euscher, Mark F. Munsel, et al. A prospective validation study of sentinel lymph node mapping for high-risk endometrial cancer. Gynecol Oncol. 2017 August ; 146(2): 234–239.
  • Referans16. Jan Persson, Sahar Salehi, Michele Bollino, Celine Lo¨nnerfors, Henrik Falconer, Barbara Geppert. Pelvic Sentinel lymph node detection in High-Risk Endometrial Cancer (SHREC-trial)dthe final step towards a paradigm shift in surgical staging. European Journal of Cancer 116 (2019) 77-85.
  • Referans17. Daraï E, Dubernard G, Bats AS, Heitz D, Mathevet P, Marret H, Querleu D, Golfier F, Leblanc E, Rouzier R, Ballester M. Sentinel node biopsy for the management of early stage endometrial cancer: long-term results of the SENTI-ENDO study. Gynecol Oncol. 2015 Jan;136(1):54-9.
  • Referans18. Mueller JJ, Pedra Nobre S, Braxton K, Alektiar KM, Leitao MM Jr, Aghajanian C, Ellenson LH, Abu-Rustum NR. Incidence of pelvic lymph node metastasis using modern FIGO staging and sentinel lymph node mapping with ultrastaging in surgically staged patients with endometrioid and serous endometrial carcinoma. Gynecol Oncol. 2020 Apr 1.
  • Referans19. Tian W, Yuanjing H, Ya H, Peisong S, Zhengchen G. A retrospective validation study of sentinel lymph node mapping for high-risk endometrial cancer. Arch Gynecol Obstet. 2019 May;299(5):1429-1435.
  • Referans20. Buda A, Gasparri ML, Puppo A, Mereu L, De Ponti E, Di Martino G, Novelli A, Tateo S, Muller M, Landoni F, Papadia A. Lymph node evaluation in high-risk early stage endometrial cancer: A multi-institutional retrospective analysis comparing the sentinel lymph node (SLN) algorithm and SLN with selective lymphadenectomy. Gynecol Oncol. 2018 Aug;150(2):261-266.
  • Referans21. J. Ehrisman, A. Alvarez Secord, A. Berchuck, P.S. Lee, N. Di Santo, M. Lopez-Acevedo, et al. Performance of sentinel lymph node biopsy in high-risk endometrial cancer. Gynecologic Oncology Reports 17 (2016) 69–71.
  • Referans22. Ducie JA, Eriksson AGZ, Ali N, McGree ME, Weaver AL, Bogani G, et al. Comparison of a sentinel lymph node mapping algorithm and comprehensive lymphadenectomy in the detection of stage IIIC endometrial carcinoma at higher risk for nodal disease. Gynecol Oncol. 2017 Dec;147(3):541-548.
  • Referans23. O. Touhami, J. Grégoire, MC. Renaud, A. Sebastianelli, M. Plante, et al.Performance of sentinel lymph node (SLN) mapping in high-risk endometrial cancer.Gynecologic Oncology 147 (2017) 549–553.
  • Referans24. Baiocchi G, Mantoan H, Kumagai LY, Gonçalves BT, Badiglian-Filho L, de Oliveira Menezes AN, Faloppa CC, De Brot L, da Costa AABA. The Impact of Sentinel Node-Mapping in Staging High-Risk Endometrial Cancer. Ann Surg Oncol. 2017 Dec;24(13):3981-3987.
  • Referans25. Schiavone MB, Scelzo C, Straight C, Zhou Q, Alektiar KM, Makker V, Soslow RA, Iasonos A, Leitao MM, Abu-Rustum NR. Survival of Patients with Serous Uterine Carcinoma Undergoing Sentinel Lymph Node Mapping. Ann Surg Oncol. 2017 Jul;24(7):1965-1971.
  • Referans26. Schiavone MB, Zivanovic O, Zhou Q, Leitao MM Jr, Levine DA, Soslow RA, Alektiar KM, Makker V, Iasonos A, Abu-Rustum NR. Survival of Patients with Uterine Carcinosarcoma Undergoing Sentinel Lymph Node Mapping. Ann Surg Oncol. 2016 Jan;23(1):196-202.
  • Referans27. Plante M, Stanleigh J, Renaud MC, Sebastianelli A, Grondin K, Grégoire J. Isolated tumor cells identified by sentinel lymph node mapping in endometrial cancer: Does adjuvant treatment matter? Gynecol Oncol. 2017 Aug;146(2):240-246.
  • Referans28. Selective Targeting of Adjuvant Therapy for Endometrial Cancer (STATEC), https://clinicaltrials.gov/ct2/show/NCT02566811.
  • Referans29. Kumar S , Podratz KC , Bakkum-Gamez JN , Dowdy SC , Weaver AL , McGree ME , et al. Prospective assessment of the prevalence of pelvic, paraaortic and high paraaortic lymph node metastasis in endometrial cancer. Gynecol Oncol. 2014;132:38–43.24120926.
  • Referans30. A.Mariani, M.J.Webb, G.L. Keeney, K.C. Podratz, Routes of lymphatic spread: a study of 112 consecutive patients with endometrial cancer, Gynecol. Oncol. 81 (2001) 100–104.
  • Referans31. Bodurtha Smith AJ, Fader AN, Tanner EJ. Sentinel lymph node assessment in endometrial cancer: a systematic review and meta-analysis. Am J Obstet Gynecol. 2017 May;216(5):459-476.
  • Referans32. Holloway RW, Abu-Rustum NR, Backes FJ, Boggess JF, Gotlieb WH, Jeffrey Lowery W, et al. sentinel lymph node mapping and staging in endometrial cancer: Society of Gynecologic Oncology literature review with consensus recommendations. Gynecol Oncol. 2017 Aug;146(2):405-415.

Yüksek Riskli Endometrium Kanserinde Sentinel Lenf Nodu Biopsisinin Yeri

Yıl 2021, Cilt: 22 Sayı: 1, 1 - 8, 22.03.2021

Öz

Endometriyum kanseri, gelişmiş ülkelerde kadın genital sisteminin en sık görülen kanseri olup, jinekojik kanserlerin başını çekmekte ve kansere bağlı ölümlerde yedinci sırada yer almaktadır. Endometriyum kanseri, tip 1 ve 2 olmak üzere iki farklı klinikopatolojik alt tipe sınıflandırılarak incelenir. Tip 2 kanser varlığı, erken dönemde metastaz yapmaya yatkın bir tümör davranışına işaret eder, trans tubal yolla peritonal yüzeylere ve lenfatik yolla retroperitonal lenf nodlarına hızlıca yayılım eğilimi gösterir. Tip 2 kanserde, nodal yayılım oranının %40’a kadar çıktığını bildiren yayınlar mevcuttur. Bunlar histolojik olarak az diferansiye tümörler olup, prognozları da kötüdür. Tip 2 kanseri olan hastaların üçte ikisinde tanı anında uterus dışına yayılmış hastalığı vardır. Yüksek riskli endometriyum kanseri olarak tanımlanan grupta şu özelliklere sahip tümörler yer almaktadır; • Evre I, Grade 3 endometrioid histoloji, myometriyal invazyon derinliği >%50, lenfovaskuler alan invazyonundan (LVAI) bağımsız. • Evre I, Endometrioid dışı histolojiler (seröz, berrak hücreli, andiferansiye tip ve karsinosarkom) • Evre II endometriyum kanseri (histolojik tipten bağımsız).
Bir çok yabancı jinekolojik onkoloji kılavuzunda (ESGO, NCCN) olduğu gibi, Türk Jinekolojik Onkoloji Derneğinin kılavuzu da; yüksek risk grubundaki endometriyal kanserli hastalara, histerektomi + bilateral salpingooferektomi (BSO) + omentektomi + pelvik ve para-aortik lenfadenektomi’yi kapsayan tam bir evreleme cerrahisi yapılması önerilmektedir. Ancak, sistematik lenfadenektomi operasyon süresini uzatmakla kalmaz, ciddi kanama gibi operatif komplikasyonlara zemin hazırlar ve post-operatif dönemde (lenfokist oluşumu, lenf ödem gelişimi gibi) morbidite artışına da neden olabilir.
Bu bağlamda, sentinel lenf nodu biyopsisi (SLNB) kavramı, hem komplikasyonları hem de morbiditeyi azaltmak için ortaya atılmış yenilikçi ve minimalist bir cerrahi yaklaşımı ifade etmektedir. SLNB, son on yılda endometriyum kanserinde çok sayıdaki özgün çalışmada değerlendirilmiş, birçok meta-analizde etkinliği araştırılmış ve artık yukarıda bahsi geçen yabancı kılavuzlarda yer edinmiştir. bununla birlikte, literatür incelendiğinde, SLNB’nin sıklıkla düşük ve orta risk grubu üzerinde çalışıldığı
göze çarpmaktadır. Yüksek risk grubu ile yapılmış sınırlı sayıda çalışma mevcuttur. Yüksek riskli hastalığın; daha az rastlanır olması, ileri evrede tanı aldığından prognozunun kötü seyretmesi ve SLNB için uygun vaka sayısının kısıtlı olması nedeniyle az sayıda çalışmaya konu olmuştur. Amerikan Ulusal Kapsamlı Kanser veri ağının (NCCN) internet sayfasında, Temmuz 2020’de yayınlanan uterin kanserler kılavuzunun son sürümü incelendiğinde (v2. 2020) ‘ Elimizdeki son kanıtlar, sentinel lenf nodu haritalamasının seröz karsinom, berrak hücreli karsinom ve karsinosarkom gibi yüksek riskli histolojilerde de kullanılabileceğini göstermektedir ‘ şeklinde güncel bir ifade yer almaktadır.
Bu derlemede, konuyla ilgili güncel literatür gözden geçirilmiş ve önemli çalışmaların sonuçları dikkate alınarak değerlendirilmiştir.

Destekleyen Kurum

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Proje Numarası

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Teşekkür

Prof. Dr. Fuat DEMİRKIRAN ve Prof. Dr. Samet TOPUZ' a bu derlemeyi yazma fırsatı verdikleri için teşekkürlerimi sunarım.

Kaynakça

  • Referans1. Pecorelli S, ed. FIGO Annual Report, years 1996–98. Int J Gynecol Obstet 2003;83:95.
  • Referans2. Brinton LA, Felix AS, McMeekin DS, et al. Etiologic heterogeneity in endometrial cancer: Evidence from a Gynecologic Oncology Group trial. Gynecol Oncol. 2013;129:277–284.
  • Referans3. Creasman WT, Odicino F, Mausinneuve P, et al. Carcinoma of the corpus uteri. FIGO Annual Report, Vol 26. Int J Gynaecol Obstet. 2006;95(suppl 1):S105–S143.
  • Referans4. Cibula D, Ooonk MH, Abu Rustum NR. Sentinel lymph node biopsy in the management of gynecologic cancer. Curr Opin Obstet Gynecol 2015;27:66-72.
  • Referans5. Nicoletta Colombo, Carien Creutzberg, Frederic Amant, et al. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer. Int J Gynecol Cancer 2016;26: 2-30.
  • Referans6. Türk Jinekolojik Onkoloji Derneği (TRSGO) jinekolojik kanserler yönetim kılavuzu el kitabı 2018.
  • Referans7. Volpi L, Sozzi G, Capozzi VA, Ricco' M, Merisio C, Di Serio M, Chiantera V, Berretta R. Long term complications following pelvic and paraortic lymphadenectomy for endometrial cancer, incidence and potential risk factors: a single institution experience. Int J Gynecol Cancer. 2019 Feb;29(2):312-319.
  • Referans8. Lheureux S, Oza AM (2016) Endometrial cancer-targeted therapies myth or reality? Review of current targeted treatments. Eur J Cancer 59:99–108.
  • Referans9. Kitchener H , Swart AM , Qian Q , Amos C , Parmar MK . Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): A randomised study. Lancet. 2009;373:125–36.
  • Referans10. Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, Scambia G, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. Journal of the National Cancer Institute. 2008; 100(23):1707–16.
  • Referans11. NCCN clinical practice guidelines in oncology (NCCN Guidelines), uterine neoplasms, version2.2020 (24 july 2020), www.nccn.org.
  • Referans12. Buda A, Crivellaro C, Elisei F, Di Martino G, Guerra L, De Ponti E, Cuzzocrea M, Giuliani D, Sina F, Magni S, Landoni C, Milani R. Impact of Indocyanine Green for Sentinel Lymph Node Mapping in Early Stage Endometrial and Cervical Cancer: Comparison with Conventional Radiotracer (99m)Tc and/or Blue Dye. Ann Surg Oncol. 2016 Jul;23(7):2183-91.
  • Referans13. Abdelazim IA, Abu-Faza M, Zhurabekova G, Shikanova S, Karimova B, Sarsembayev M, Starchenko T, Mukhambetalyeva G. Sentinel Lymph Nodes in Endometrial Cancer Update 2018. Gynecol Minim Invasive Ther. 2019 Aug 29;8(3):94-100.
  • Referans14. Robert W. Holloway, Nadeem R. Abu-Rustum, Floor J. Backes, John F. Boggess, Walter H. Gotlieb, et. al. Sentinel Lymph Node Mapping and Staging in Endometrial Cancer: A Society of Gynecologic Oncology Literature Review with Consensus Recommendations. Gynecol Oncol. 2017 August ; 146(2): 405–415.
  • Referans15. Pamela T. Soliman, Shannon N. Westin, Shayan Dioun, Charlotte C. Sun, Elizabeth Euscher, Mark F. Munsel, et al. A prospective validation study of sentinel lymph node mapping for high-risk endometrial cancer. Gynecol Oncol. 2017 August ; 146(2): 234–239.
  • Referans16. Jan Persson, Sahar Salehi, Michele Bollino, Celine Lo¨nnerfors, Henrik Falconer, Barbara Geppert. Pelvic Sentinel lymph node detection in High-Risk Endometrial Cancer (SHREC-trial)dthe final step towards a paradigm shift in surgical staging. European Journal of Cancer 116 (2019) 77-85.
  • Referans17. Daraï E, Dubernard G, Bats AS, Heitz D, Mathevet P, Marret H, Querleu D, Golfier F, Leblanc E, Rouzier R, Ballester M. Sentinel node biopsy for the management of early stage endometrial cancer: long-term results of the SENTI-ENDO study. Gynecol Oncol. 2015 Jan;136(1):54-9.
  • Referans18. Mueller JJ, Pedra Nobre S, Braxton K, Alektiar KM, Leitao MM Jr, Aghajanian C, Ellenson LH, Abu-Rustum NR. Incidence of pelvic lymph node metastasis using modern FIGO staging and sentinel lymph node mapping with ultrastaging in surgically staged patients with endometrioid and serous endometrial carcinoma. Gynecol Oncol. 2020 Apr 1.
  • Referans19. Tian W, Yuanjing H, Ya H, Peisong S, Zhengchen G. A retrospective validation study of sentinel lymph node mapping for high-risk endometrial cancer. Arch Gynecol Obstet. 2019 May;299(5):1429-1435.
  • Referans20. Buda A, Gasparri ML, Puppo A, Mereu L, De Ponti E, Di Martino G, Novelli A, Tateo S, Muller M, Landoni F, Papadia A. Lymph node evaluation in high-risk early stage endometrial cancer: A multi-institutional retrospective analysis comparing the sentinel lymph node (SLN) algorithm and SLN with selective lymphadenectomy. Gynecol Oncol. 2018 Aug;150(2):261-266.
  • Referans21. J. Ehrisman, A. Alvarez Secord, A. Berchuck, P.S. Lee, N. Di Santo, M. Lopez-Acevedo, et al. Performance of sentinel lymph node biopsy in high-risk endometrial cancer. Gynecologic Oncology Reports 17 (2016) 69–71.
  • Referans22. Ducie JA, Eriksson AGZ, Ali N, McGree ME, Weaver AL, Bogani G, et al. Comparison of a sentinel lymph node mapping algorithm and comprehensive lymphadenectomy in the detection of stage IIIC endometrial carcinoma at higher risk for nodal disease. Gynecol Oncol. 2017 Dec;147(3):541-548.
  • Referans23. O. Touhami, J. Grégoire, MC. Renaud, A. Sebastianelli, M. Plante, et al.Performance of sentinel lymph node (SLN) mapping in high-risk endometrial cancer.Gynecologic Oncology 147 (2017) 549–553.
  • Referans24. Baiocchi G, Mantoan H, Kumagai LY, Gonçalves BT, Badiglian-Filho L, de Oliveira Menezes AN, Faloppa CC, De Brot L, da Costa AABA. The Impact of Sentinel Node-Mapping in Staging High-Risk Endometrial Cancer. Ann Surg Oncol. 2017 Dec;24(13):3981-3987.
  • Referans25. Schiavone MB, Scelzo C, Straight C, Zhou Q, Alektiar KM, Makker V, Soslow RA, Iasonos A, Leitao MM, Abu-Rustum NR. Survival of Patients with Serous Uterine Carcinoma Undergoing Sentinel Lymph Node Mapping. Ann Surg Oncol. 2017 Jul;24(7):1965-1971.
  • Referans26. Schiavone MB, Zivanovic O, Zhou Q, Leitao MM Jr, Levine DA, Soslow RA, Alektiar KM, Makker V, Iasonos A, Abu-Rustum NR. Survival of Patients with Uterine Carcinosarcoma Undergoing Sentinel Lymph Node Mapping. Ann Surg Oncol. 2016 Jan;23(1):196-202.
  • Referans27. Plante M, Stanleigh J, Renaud MC, Sebastianelli A, Grondin K, Grégoire J. Isolated tumor cells identified by sentinel lymph node mapping in endometrial cancer: Does adjuvant treatment matter? Gynecol Oncol. 2017 Aug;146(2):240-246.
  • Referans28. Selective Targeting of Adjuvant Therapy for Endometrial Cancer (STATEC), https://clinicaltrials.gov/ct2/show/NCT02566811.
  • Referans29. Kumar S , Podratz KC , Bakkum-Gamez JN , Dowdy SC , Weaver AL , McGree ME , et al. Prospective assessment of the prevalence of pelvic, paraaortic and high paraaortic lymph node metastasis in endometrial cancer. Gynecol Oncol. 2014;132:38–43.24120926.
  • Referans30. A.Mariani, M.J.Webb, G.L. Keeney, K.C. Podratz, Routes of lymphatic spread: a study of 112 consecutive patients with endometrial cancer, Gynecol. Oncol. 81 (2001) 100–104.
  • Referans31. Bodurtha Smith AJ, Fader AN, Tanner EJ. Sentinel lymph node assessment in endometrial cancer: a systematic review and meta-analysis. Am J Obstet Gynecol. 2017 May;216(5):459-476.
  • Referans32. Holloway RW, Abu-Rustum NR, Backes FJ, Boggess JF, Gotlieb WH, Jeffrey Lowery W, et al. sentinel lymph node mapping and staging in endometrial cancer: Society of Gynecologic Oncology literature review with consensus recommendations. Gynecol Oncol. 2017 Aug;146(2):405-415.
Toplam 32 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Cerrahi
Bölüm Derleme
Yazarlar

Yağmur Minareci

Özgür A. Tosun Bu kişi benim

Hamdullah Sözen

Samet Topuz

Yavuz Salihoglu

Proje Numarası -
Yayımlanma Tarihi 22 Mart 2021
Gönderilme Tarihi 7 Ekim 2020
Yayımlandığı Sayı Yıl 2021 Cilt: 22 Sayı: 1

Kaynak Göster

APA Minareci, Y., Tosun, Ö. A., Sözen, H., Topuz, S., vd. (2021). Yüksek Riskli Endometrium Kanserinde Sentinel Lenf Nodu Biopsisinin Yeri. Türk Jinekolojik Onkoloji Dergisi, 22(1), 1-8.
AMA Minareci Y, Tosun ÖA, Sözen H, Topuz S, Salihoglu Y. Yüksek Riskli Endometrium Kanserinde Sentinel Lenf Nodu Biopsisinin Yeri. TRSGO Dergisi. Mart 2021;22(1):1-8.
Chicago Minareci, Yağmur, Özgür A. Tosun, Hamdullah Sözen, Samet Topuz, ve Yavuz Salihoglu. “Yüksek Riskli Endometrium Kanserinde Sentinel Lenf Nodu Biopsisinin Yeri”. Türk Jinekolojik Onkoloji Dergisi 22, sy. 1 (Mart 2021): 1-8.
EndNote Minareci Y, Tosun ÖA, Sözen H, Topuz S, Salihoglu Y (01 Mart 2021) Yüksek Riskli Endometrium Kanserinde Sentinel Lenf Nodu Biopsisinin Yeri. Türk Jinekolojik Onkoloji Dergisi 22 1 1–8.
IEEE Y. Minareci, Ö. A. Tosun, H. Sözen, S. Topuz, ve Y. Salihoglu, “Yüksek Riskli Endometrium Kanserinde Sentinel Lenf Nodu Biopsisinin Yeri”, TRSGO Dergisi, c. 22, sy. 1, ss. 1–8, 2021.
ISNAD Minareci, Yağmur vd. “Yüksek Riskli Endometrium Kanserinde Sentinel Lenf Nodu Biopsisinin Yeri”. Türk Jinekolojik Onkoloji Dergisi 22/1 (Mart 2021), 1-8.
JAMA Minareci Y, Tosun ÖA, Sözen H, Topuz S, Salihoglu Y. Yüksek Riskli Endometrium Kanserinde Sentinel Lenf Nodu Biopsisinin Yeri. TRSGO Dergisi. 2021;22:1–8.
MLA Minareci, Yağmur vd. “Yüksek Riskli Endometrium Kanserinde Sentinel Lenf Nodu Biopsisinin Yeri”. Türk Jinekolojik Onkoloji Dergisi, c. 22, sy. 1, 2021, ss. 1-8.
Vancouver Minareci Y, Tosun ÖA, Sözen H, Topuz S, Salihoglu Y. Yüksek Riskli Endometrium Kanserinde Sentinel Lenf Nodu Biopsisinin Yeri. TRSGO Dergisi. 2021;22(1):1-8.