Sentinel node biopsy in endometrial cancer: an update

Aim: A review was conducted to update the recent published literature on sentinel lymph-node (SLN) procedures in endometrial cancer. Materials and methods: A comprehensive literature search was performed in PubMed and Cochrane library, searching from English language publication of the last 10 years about sentinel lymph node (SLN) in endometrial cancer. Eligible studies had a sample size > 30 patients and reported at least the detection rate. Detection rate, bilateral mapping rate, sensitivity (SN), and negative predictive value (NPV) were evaluated. Different techniques were assessed both for detection rate and for bilateral mapping. A subgroup analysis on studies focused on SPET was performed. Results: Forty studies were considered for the analysis (6162 patients). The overall detection rate of SLN mapping was 87.7% (95% CI 77.6–97.9%, range 62–100%). The pooled bilateral mapping rate was 59.9% (95% CI 43.2–76.6%, range 21–92%). The pooled SN resulted 98.3% (range: 50–100%) and the pooled NPV was 99.5% (range 86–100%). Cervical injection was the most used technique. Indocyanine green (ICG) and the combination of radiotracer/blue dye resulted in the highest SLN detection rates: 95% (95% CI 86–100%) and 90% (95% CI 79–100%) with cervical injection, respectively. ICG demonstrated the highest values of bilateral nodal mapping 75% (95% CI 60–91%) with cervical injection. Studies focused on SPET/CT showed a low/moderate correlation between SPET imaging and intraoperative findings. Conclusion: SLN mapping accurately predicts nodal status in women with endometrial cancer. Future prospective evaluation of prognosis/outcome is needed to define the impact of this technique for personalized therapy