Sentinel Lymph Node in Endometrial Cancer: A Review

Lymph node status is a major prognostic factor in endometrial cancer (EC). Sentinel lymph node (SLN) biopsy has been reported in EC for more than 15 years but has not yet been incorporated as a standard-of-care procedure in EC. Complex uterine drainage, the various modalities of tracer injection, and the lack of large prospective series may explain this situation. In this review, we report an SLN detection rate of 81.7 %, a 10.9 % rate of metastatic SLN involvement, and a false-negative rate of 12.3 % in the main clinical trials. Thirty-five percent of SLN metastases were low-volume disease (micrometastases or isolated tumor cells). These data raise the question of the clinical significance of low-volume disease in EC. SLN biopsy could allow upstaging in supposedly low- or intermediate-risk patients in whom adjuvant therapy could be omitted. Further studies are required to precise the interest on the survival of this procedure in this subset of patients.