Sentinel Lymph Node Mapping in Early-Stage Endometrial Cancer: A Systematic Review and Meta-Analysis

Abstract

Introduction: The management of lymph nodes in endometrial cancer is controversial. Sentinel lymph node (SLN) mapping has emerged as an alternative to full pelvic lymphadenectomy to reduce surgical morbidity while maintaining staging accuracy. This review assesses the diagnostic accuracy of SLN mapping.

Methods: A systematic review of prospective studies was performed. We included studies that performed SLN mapping followed by a completion lymphadenectomy, allowing for the calculation of detection rates and diagnostic accuracy. The primary outcome was the negative predictive value (NPV).

Results: The meta-analysis of over 50 studies showed a high pooled detection rate and a very high sensitivity and NPV. The false negative rate was low, particularly when a specific mapping algorithm was followed, including uterine manipulation and cervical injection.

Discussion: SLN mapping is a reliable and accurate method for staging early-stage endometrial cancer. It allows for the identification of patients who can safely avoid a full lymphadenectomy, thereby reducing the risk of lymphedema and other surgical morbidities.

Conclusion: Sentinel lymph node mapping is a safe and accurate alternative to full lymphadenectomy for staging early-stage endometrial cancer.