Introduction:

The lymph node status is of utmost importance in endometrial cancer staging. However, the therapeutic importance of systematic lymphadenectomy was not proven, thus the sentinel lymph node biopsy (SLNB) is emerging as an alternative to classic surgical staging procedure. We aimed to evaluate the feasibility of SLNB in clinical early-stage endometrial cancer, at a university-affiliated teaching hospital.

Material and Methods:

Retrospective, single-centre, observational analysis, including patients with clinical stage I or II endometrial cancer, submitted to minimally invasive primary surgery. Patients underwent sentinel lymph node mapping with indocyanine green dye, after cervical injection, from September 2019 to September 2022. The ultra-staging protocol was followed. The map rate, sensitivity, negative predictive value, and false negatives were calculated.

Results:

Fifty-six patients met the inclusion criteria. The overall and bilateral detection rate was o 96.4% and 80.3%, respectively. After SLNB, complete pelvic lymphadenectomy was performed in 33.9% of patients. Lymphatic metastases were found in 6 (10.7%) cases, all of them in sentinel lymph node sampling. Four patients, with pre-operative low-risk of recurrence, had bilateral SLNB and the histopathological evaluation revealed micrometastases. Two patients, who underwent pelvic lymphadenectomy, had macrometastases. The sensitivity and negative predictive value of SLNB were 100%, with a false negative rate of 0%. Comparative analysis between the groups with a low-risk of recurrence, that underwent SLNB alone, and intermediate/high-risk groups, that performed systematic lymphadenectomy, showed a significant difference in surgery duration, hospital stay, and complication rate (higher in the systematic lymphadenectomy group). There were no adverse effects related to the indocyanine green injection.

Conclusion:

SLNB is a safe procedure, with a high detection rate and sensitivity, avoiding the morbidities related to systematic lymphadenectomy. The implementation of the ultra-staging protocol is crucial to allow the diagnosis of the low-volume metastatic involvement, influencing the definitive staging of apparently low-risk patients.

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