Study finds low lymphedema risk after SLN mapping in endometrial cancer

Study finds low lymphedema risk after SLN mapping in endometrial cancer | Image Credit: © Chutima - © Chutima - stock.adobe.com.

The odds of lymphedema after sentinel lymph node (SLN) mapping are low among women with low-grade endometrial cancer (EC), according to a recent study published in the American Journal of Obstetrics & Gynecology.¹

SLN mapping and its role in endometrial cancer staging

SLN mapping is the primary method of surgical staging among women with EC, with a well-established diagnostic safety even among women with high-grade disease. Myometrial invasion rates for lymph node metastases are under 50% in women with low-grade EC, but hurdles to preoperative evaluation highlight SLN mapping as a potential method to balance lymph node metastases detection with complication risks.²

“However, there is limited knowledge of early and late lymphedema and its impact on quality of life (QoL) in women with low-grade EC following the SLN procedure,” wrote investigators.¹ “The benefits of detecting metastases in a comparatively low proportion of these women should balance the risk of lymphedema.”

Study design and methods

Therefore, investigators conducted a study to assess lymphedema risk after LN mapping among women with low-grade EC. Women with low-grade histology stage 1 EC visiting certain gynecological cancer centers in Denmark between March 2017 and March 2022 were included in the analysis.

An internationally recognized surgical algorithm was referenced for SLN mapping. Patient-reported outcome measures (PROMs) were completed by patients through e-mail of post before surgery and at 3, 12, 24, and 36 months after surgery.

The European Organisation for Research and Treatment of Cancer (EORTC) generic core modules EORTC QLQ-C30 and EORTC QLQ-EN24 were included as PROMs. Other PROMs included 7 EORTC items assessing potential lymphedema locations and symptomology, alongside the Lymphedema Quality of Life Tool (LYMQOL).

The LYMQOL questionnaire was completed by women answering “a little,” “quite a bit,” or “very much” to any of the QLQ-EN24 or supplementary items related to leg, groin, or genital swelling. This was done because the current cut-off value used has not been validated.

A 4-point Likert scale was used for all responses. Sociodemographic and clinical questions were also included at baseline to obtain family relations, education level, performance status, and comorbidities data.

Key findings

There were 486 women with complete responses included in the final analysis. The clinical importance of 8 points on a scale of 0 to 100 was not reached by any difference score. However, the difference score from baseline to 12 months for the leg sum-score was statistically different at 5.

In comparison, the leg score did not significantly change from month 3 to month 12 at 0.7. Increases in self-reported skin tightness and leg pain between baseline and month 12 were 4.5 and 5.7, respectively, highlighting clinical importance. However, only minor increases were reported for the remaining 5 items assessing lymphedema in the groin and genital area.

Associations were reported between body mass index and baseline leg swelling score with 12-month lymphedema score, with a regression coefficient of 0.34. Additionally, a regression coefficient of 3.83 was reported for removal of more lymph nodes.

The lymphedema score was significantly associated with all 5 LYMQOL domains, with regression coefficients of -0.49, -0.46, -0.21, 0.58, and -0.45 for daily activity function, appearance, emotion, symptoms, and global QoL, respectively. A response changing from “not at all” to “quite a bit” or “very much” was reported in 2.1% of cases for swelling and 3.7% for heaviness.

Conclusion

These results indicted low odds of developing lymphedema among women with low-grade EC receiving surgical staging with SLN mapping. Additionally, lymphedema presence at 3 months was effective for predicting lymphedema presence at 12 months.

“The few women with high scores of leg lymphedema at 12 months reported impairment in several aspects of their QoL,” wrote investigators. “These data support the adoption of SLN mapping for women with low-grade EC to ensure correct allocation to adjuvant therapy.”

References

1. Bjørnholt SM, Groenvold M, Petersen MA, et al. Patient-reported lymphedema after sentinel lymph node mapping in women with low-grade endometrial cancer. Am J Obstet Gynecol. 2025;232:306.e1-11. doi:10.1016/j.ajog.2024.09.001
2. Colombo N, Creutzberg C, Amant F, et al. ESMO-ESGO-ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up. Ann Oncol. 2016;27(1):16-41. doi:10.1093/annonc/mdv484