Update on Sentinel Lymph Node Mapping in Endometrial Cancer Patients with a High Risk for Nodal Metastasis

Purpose of review: Clinical trials have demonstrated the accuracy of SLN mapping in detecting nodal spread in patients with endometrial cancer. However, data regarding the oncological outcomes of this approach, particularly in the setting endometrial cancer with a high risk of nodal spread, are still lacking. In this review, we provide an overview of SLN mapping in endometrial cancer. We will specifically discuss its use in patients at high risk of nodal metastasis. Controversies and future directions for research will also be discussed. Summary of the findings: High-quality data from prospective studies have shown that SLN mapping is as accurate as systematic lymphadenectomy. Retrospective analyses have suggested that SLN mapping does not appear to compromise oncological outcomes, compared to systematic lymphadenectomy in high-risk endometrial cancer. Conclusion: In light of published retrospective data suggesting that SLN mapping in high-risk endometrial cancer does not jeopardize oncological outcomes and may even be better in identifying patients who need adjuvant treatment, SLN mapping may prove to be the optimal surgical management of these high-risk patients. Future studies on SLN mapping should focus on oncological outcomes and the management of micrometastases and ITCs that cannot be identified without ultrastaging.