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Using dye to map cancer metastases, UNC led a large-scale study to help patients avoid complications from surgery. UNC Lineberger members Anastasia Ivanova, PhD, and John Boggess, MD, were co-authors.

Anastasia Ivanova, PhD, and John Boggess, MD

UNC researchers published a study in Lancet Oncology that identifies sentinel-lymph-node mapping as a safer and less-invasive method of staging endometrial cancer that is equally as accurate as the more traditional lymphadenectomy.

The study was led by first author Emma Rossi, MD, of the UNC Department of Obstetrics and Gynecology’s Division of Gynecologic Oncology, with Anastasia Ivanova, PhD, a UNC Lineberger Comprehensive Cancer Center member and associate professor in the UNC Gillings School of Global Public Health, and John Boggess, MD, a UNC Lineberger member and professor in the UNC School of Medicine.

For lymphadenectomy, large sections of tissue on both sides of the uterus are removed to check for lymph nodes that contain metastases, enabling the surgeon to stage the cancer and home in on the best course of treatment for patients. The sentinel nodes are the lymph nodes adjacent to a cancerous tumor and into which fluid from the tumor drains. With this method, surgeons can identify these nodes by injecting a small amount of dye into the uterus and detecting which lymph nodes absorb the dye. Instead of having to remove large amounts of tissue to find impacted nodes, only the nearby sentinel lymph nodes are removed.

This less-invasive procedure reduces the risk of side effects such as scar tissue build-up and the more long-term debilitating side effects such as lymphedema, the excess build-up of fluid in tissue.

“With fewer lymph nodes removed, there is less damage to the patient’s tissue and therefore less trauma to the patient,” said Rossi, assistant professor of obstetrics and gynecology at the UNC School of Medicine and the study’s principal investigator. “The concept is that reviewing a smaller number of more specific lymph nodes is a lower-volume, higher-quality procedure. Our study showed that this procedure is just as accurate as lymphadenectomy.”

This study – known as the FIRES trial – was the largest, most conclusive study on the accuracy of this technology on endometrial cancer.

UNC’s Division of Gynecologic Oncology was the primary enrolling site, seeing 200 of the 356 patients enrolled. UNC provided six participating surgeons, including Rossi, the study’s principal investigator and Boggess, the co-investigator, who are faculty in the UNC Department of Obstetrics and Gynecology’s Division of Gynecologic Oncology and members of UNC Lineberger.