OSNA Versus Ultrastaging to Detect Sentinel Lymph Node Metastasis in Endometrial Cancer

NCT ID: NCT06935305

Last Updated: 2025-11-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

1922 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-07-30

Study Completion Date

2029-03-17

Brief Summary

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Patients enrolled in the study will be randomized before surgery: in one study arm, the search for lymph node metastases in surgically removed sentinel lymph nodes will occur using the ultrastaging method (standard), while in the other arm it will be conducted using the OSNA method.

Detailed Description

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This is a non-inferiority randomized trial with the incidence of patients with metastatic SLN as primary endpoint. Based on recent literature, incidence of patients with metastatic SLN detected by ultrastaging has an average value of 11%. Assuming a -4% as the maximum allowable difference in detection rate to declare non-inferiority, a power of 80% and a significance level of 2.5% (one-side) a sample size of 1922 (961 per arm) is needed. Two interim analyses are planned, one after the first 640 and the second after 1280 patients. At the first interim analysis null hypothesis (inferiority of OSNA with respect to ultrastaging) will be rejected at a significance level \<0.00010 otherwise the study will go on and at the second analysis the null hypothesis will be rejected at a significance level of 0.0059. The final analysis will use 0.0189 as significance threshold. The O'Brien Fleming alpha spending function was used to define these values.

The primary endpoint is defined as the proportion of patients with positive SLN over the total of randomized patients. This proportion will be reported together with the 95% confidence interval to better identify the range of inferential values. Incidence of isolated tumor cells, micro- and macro-metastasis will be calculated.

Number of copies of CK19 mRNA to define volume of metastases will be adapted from previous reports.

To describe the sample, quantitative variables will be summarized using median and interquartile range while categorical items will be reported as absolute counts and percentages. Patients will be described according the arm they were randomized to. A first analysis will be performed on an Intent-To-Treat basis, considering all randomized patients. A secondary analysis will be performed on the Per-Protocol population.

Conditions

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Endometrial Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Patients enrolled in the study will be randomized before surgery: in one study arm, the search for lymph node metastases in surgically removed sentinel lymph nodes will occur using the ultrastaging method (standard), while in the other arm it will be conducted using the OSNA method.
Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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ultrastaging arm

In this study arm, the search for lymph node metastases in surgically removed sentinel lymph nodes will occur using the ultrastaging method (standard)

Group Type ACTIVE_COMPARATOR

Ultrastaging

Intervention Type DEVICE

The search for lymph node metastases in surgically removed sentinel lymph nodes will occur using the ultrastaging method

OSNA arm

In this arm the search for lymph node metastases in surgically removed sentinel lymph nodes will occur using the OSNA method (experimental)

Group Type EXPERIMENTAL

OSNA

Intervention Type DEVICE

The search for lymph node metastases in surgically removed sentinel lymph nodes will occur using the OSNA method

Interventions

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OSNA

The search for lymph node metastases in surgically removed sentinel lymph nodes will occur using the OSNA method

Intervention Type DEVICE

Ultrastaging

The search for lymph node metastases in surgically removed sentinel lymph nodes will occur using the ultrastaging method

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Histologically confirmed endometrial cancer
* Apparent (pre-operative) FIGO stage I-II
* Radical surgery
* Attempt of SLN mapping

Exclusion Criteria

* Uterine sarcoma (including endometrial stromal sarcoma)
* Fertility sparing surgery
* Dedifferentiated histology
* Undifferentiated histology
* Neoadjuvant therapy
* Previous surgery to pelvic lymph nodes
* Lymph nodes with short axis \>15 mm at pre-operative imaging
Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Sysmex Europe GmbH

INDUSTRY

Sponsor Role collaborator

Fondazione Policlinico Universitario Agostino Gemelli IRCCS

OTHER

Sponsor Role lead

Responsible Party

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Fanfani Francesco

Professor Francesco Fanfani

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Francesco Fanfani, Professor

Role: PRINCIPAL_INVESTIGATOR

Fondazione Policlinico Agostino Gemelli IRCCS

Locations

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Fondazione Policlinico Universitario Agostino Gemelli IRCCS

Rome, Italy, Italy

Site Status RECRUITING

Countries

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Italy

Central Contacts

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Francesco Fanfani, Professor

Role: CONTACT

+390630153421

Nicolò Bizzarri, Dr

Role: CONTACT

+393471771680

Facility Contacts

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Francesco Fanfani

Role: primary

+39 0630153421

References

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Marchocki Z, Cusimano MC, Clarfield L, Kim SR, Fazelzad R, Espin-Garcia O, Bouchard-Fortier G, Rossi EC, Stewart KI, Soliman PT, How JA, Gotlieb WH, Holloway RW, Ianieri MM, Cabrera S, Lim YK, Ferguson SE. Sentinel lymph node biopsy in high-grade endometrial cancer: a systematic review and meta-analysis of performance characteristics. Am J Obstet Gynecol. 2021 Oct;225(4):367.e1-367.e39. doi: 10.1016/j.ajog.2021.05.034. Epub 2021 May 29.

Reference Type BACKGROUND
PMID: 34058168 (View on PubMed)

Persson J, Salehi S, Bollino M, Lonnerfors C, Falconer H, Geppert B. Pelvic Sentinel lymph node detection in High-Risk Endometrial Cancer (SHREC-trial)-the final step towards a paradigm shift in surgical staging. Eur J Cancer. 2019 Jul;116:77-85. doi: 10.1016/j.ejca.2019.04.025. Epub 2019 Jun 7.

Reference Type BACKGROUND
PMID: 31181536 (View on PubMed)

Koh WJ, Abu-Rustum NR, Bean S, Bradley K, Campos SM, Cho KR, Chon HS, Chu C, Cohn D, Crispens MA, Damast S, Dorigo O, Eifel PJ, Fisher CM, Frederick P, Gaffney DK, George S, Han E, Higgins S, Huh WK, Lurain JR 3rd, Mariani A, Mutch D, Nagel C, Nekhlyudov L, Fader AN, Remmenga SW, Reynolds RK, Tillmanns T, Ueda S, Wyse E, Yashar CM, McMillian NR, Scavone JL. Uterine Neoplasms, Version 1.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2018 Feb;16(2):170-199. doi: 10.6004/jnccn.2018.0006.

Reference Type BACKGROUND
PMID: 29439178 (View on PubMed)

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.e10. doi: 10.1016/j.ajog.2016.11.1033. Epub 2016 Nov 18.

Reference Type BACKGROUND
PMID: 27871836 (View on PubMed)

Bogani G, Murgia F, Ditto A, Raspagliesi F. Sentinel node mapping vs. lymphadenectomy in endometrial cancer: A systematic review and meta-analysis. Gynecol Oncol. 2019 Jun;153(3):676-683. doi: 10.1016/j.ygyno.2019.03.254. Epub 2019 Apr 2.

Reference Type BACKGROUND
PMID: 30952370 (View on PubMed)

Concin N, Matias-Guiu X, Vergote I, Cibula D, Mirza MR, Marnitz S, Ledermann J, Bosse T, Chargari C, Fagotti A, Fotopoulou C, Gonzalez Martin A, Lax S, Lorusso D, Marth C, Morice P, Nout RA, O'Donnell D, Querleu D, Raspollini MR, Sehouli J, Sturdza A, Taylor A, Westermann A, Wimberger P, Colombo N, Planchamp F, Creutzberg CL. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer. 2021 Jan;31(1):12-39. doi: 10.1136/ijgc-2020-002230. Epub 2020 Dec 18.

Reference Type BACKGROUND
PMID: 33397713 (View on PubMed)

Lortet-Tieulent J, Ferlay J, Bray F, Jemal A. International Patterns and Trends in Endometrial Cancer Incidence, 1978-2013. J Natl Cancer Inst. 2018 Apr 1;110(4):354-361. doi: 10.1093/jnci/djx214.

Reference Type BACKGROUND
PMID: 29045681 (View on PubMed)

Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin. 2021 Jan;71(1):7-33. doi: 10.3322/caac.21654. Epub 2021 Jan 12.

Reference Type BACKGROUND
PMID: 33433946 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

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7170

Identifier Type: -

Identifier Source: org_study_id

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