From systematic lymphadenectomy to sentinel lymph node mapping: a review on transitions and current practices in endometrial cancer staging

Endometrial cancer care has undergone major changes in the past 30 years. In 1988, staging transitioned from clinical to surgical. Moreover, the surgical approach of choice is no longer open surgery, but minimally invasive surgery. An improvement in terms of nodal evaluation followed. Full systematic lymphadenectomy has been continuously replaced by sentinel lymph node mapping. Although sentinel lymph node mapping with a cervical injection of indocyanine green dye is rapidly gaining clinical acceptance, we lack consistent recommendations on a well-defined procedure that accurately and indolently assesses the lymph node status. Such recommendations are indispensable, as nodal status is the most important predictive factor of survival and is essential for tailoring adjuvant treatment to the risk of recurrence. This paper focuses on transitions in endometrial cancer care and highlights current data on sentinel lymph node mapping in endometrial cancer. We demonstrate that sentinel lymph node mapping is a safe and accurate strategy for nodal status evaluation with appropriate sensitivity, false-negative rate and negative predictive value in high- as well as low-risk settings. Furthermore, we elaborate on type and dose of tracer, site of injection, number of sentinel lymph nodes to be removed, sentinel lymph node mapping learning curve, operation mode and sentinel lymph node ultrastaging. In the future, guidelines with consistent recommendations on the above outlined features of sentinel lymph node mapping should be established to allow for a uniform and wide-spread application of the sentinel lymph node mapping procedure.