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Introduction/Background* The aim of this study is to present the final results of the study of dual cervical and fundal injection with ICG in endometrial cancer for sentinel lymph node detection. The hypothesis of this study is that fundal injection does not obviate the infundibulo-pelvic drainage pathway and improves the detection of the aortic sentinel lymph node, making it possible to add aortic mapping to the excellent pelvic mapping achieved by cervical injection. Methodology This is a 6-year (June 2014-December 2020) prospective, observational cohort study with 332 patients evaluated. Inclusion criteria were early endometrial cancer, and low/intermediate or high risk criteria of the ESMO/ESGO/ESTRO 2014. Sentinel lymph node (SLN) biopsy with dual cervical and fundal indocyanine green injection was performed in all cases, associating aorto-caval lymphadenectomy up to the left renal vein in intermediate and high risk cases. Result(s)* Detection rate (DR) was 94%. Pelvic DR, Bilateral Pelvic and Aortic Dr was 91.3%, 70.5% and 67.2%. The DR of all the anatomical areas (left & right pelvic & aortic) was 53.6%. Sentinel node detection improved overall detection by 3%. There were a total of 16.9% positive nodes for macrometastases or low-volume disease, 1 out of 4 isolated lymph node metastases corresponds to the aortic area. Sensitivity was 98.3% (95% CI 91-99.7), specificity 100% (95% CI 98.5-100), NPV 99.6% (95% CI 97.8-99.9) and PPV 100% (95% CI 93.8-100). Conclusion* Dual fundic and cervical injection is a feasible technique, which provides additional mapping of the aortic area and allows improved sentinel node detection rates in endometrial cancer, allowing detection of otherwise missed aortic lymph node involvement, which corresponds to a quarter of stage IIIC, and thus a greater number of cases of lymph node involvement that are not limited to the pelvic area.

Introduction/Background Approximately 10% of patients with intraoperative diagnosis of low risk Endometrial Cancer (EC) will suffer an upstage after the definitive histological evaluation of the piece of hysterectomy and bilateral adnexectomy, We aim to explore the results associated with the performance of pelvic and para-aortic lymphadenectomy as restaging these patients that will require a second surgery, and to compare those with and without Sentinel Node Biopsy (SNB) in the first procedure. Methodology Retrospective cohort study involving 27 patients diagnosed with low-risk EC (ESMO-ESGO-ESTRO criteria) with surgical restaging due to upstage in the final histological result at the Hospital Universitario Donostia from April 2013 to September 2018. Surgical and oncological results were compared between patients who underwent hysterectomy and double adnexectomy without any additional procedure (SNB-) n=17 and those who also had a pelvic and aortic SNB (SNB+) n=10.The main outcome evaluated in the study was intraoperative complications. Secondary outcomes were mean operative time, length of hospital stay, number of nodes obtained, Progression-Free Survival (PFS) and Overall Survival (OS). Results The median duration of restaging surgery was 240 minutes (Q25 - Q75: 180 – 300) in the SNB(-) group, and 300 (Q25 - Q75: 247.5 – 330) minutes in the SNB(+) group, this difference being statistically significant (one-side t-student test, p=0.0295). With regard to intraoperative complications, there were 17.65% vs 40% respectively, all of them vascular, this difference being not significant. There were no statistical differences in length of hospital stay and number of pelvic nodes obtained. PFS and OS in both groups were the same. Conclusion Women with EC who require lymph node restaging due to upstage and have previously undergone sentinel lymph node biopsy have greater surgical difficulty with longer duration of the procedure. The risk of complications is increased.We advise against performing a second re-staging surgery in patients sentinel node biopsy. Disclosures No disclosures.

Introduction/Background Sentinel node in endometrial cancer (EC) is an evolving technique to know the nodal status in a more precise way without the need to perform a complete lymphadenecotomy. The aim of this study was to describe our latest results using dual cervical and fundal indocyanine green (ICG) injection for detection of sentinel lymph node (SLN) in endometrial cancer and results of SLN biopsy. Methodology This is an observational prospective study performed between 26 June 2014 and 31 December 2019, 278 patients underwent laparoscopic surgery for endometrial cancer at Hospital Uniersitario Donostia, in Spain. In all cases, we performed SLN biopsy with dual cervical and fundal ICG injection, looking for pelvic and aortic sentinel node. All SLNs were processed with an ultrastaging technique. A total of 128 patients with Intermediate and High risk EC also underwent total pelvic and paraaortic lymphadenectomy. Results The detection rates were as follows: 93.52% (260/278) overall for SLNs; 90.65% (252/278) overall for pelvic SLNs; 67.99% (189/278) for bilateral SLNs; 66.91% (186/278) for paraaortic SLNs, and 2.88% (8/278) for isolated paraaortic SLNs. We found macroscopic lymph node metastasis in 26 patients (10.03%) and microdisease in lymph nodes in another 48 patients, raising the overall rate of lymph node involvement to 16.19%. There was one false negative (negative SLN biopsy but positive lymphadenectomy). 6.6% of all pelvic and also aortic sentinel nodes were positive for metastasis. Applying the SN algorithm, the sensitivity of detection was 97.9% (95% CI 89.1–99.6), specificity 100% (95% CI 98.2–100), negative predictive value 99.5% (95% CI 97.4–99.9), and positive predictive value 100% (95% CI 92.4–100). Conclusion Dual sentinel node injection is a feasible technique that achieves adequate detection rates. Additionally, this technique allows a high rate of aortic detection, identifying a non-negligible percentage of isolated aortic metastases. Aortic metastases in endometrial cancer are possible and it is necessary to investigate the relevance of its detection. Disclosures No disclosures.