Role of sentinel lymph node dissection
In early-stage EC, systematic LND plays a role in complementing preoperative imaging and is fundamental to guide adjuvant treatment. Sentinel lymph nodes (SLN) are the first to be involved with metastatic cancer cells and therefore require detailed examination known as ultrastaging(56). This procedure involves SLN dissection (SLND) and biopsy guided by SLN mapping(3). A variety of SLN algorithms have shown similar diagnostic accuracies to MRI(57) and systematic LND(58), therefore ESMO-ESGO-ESTRO 2016 recognises SLND as a relatively novel alternative to systematic LND.
Since 2016, the significance of SLND due to its enhanced benefits have been further substantiated. In high-risk patients, SLN mapping has shown high detection rates of LN metastases(59). However, this study demonstrated a false-negative rate of 22%, perhaps due to its small (n = 53), single-centre study design. The Fluorescence Imaging for Robotic Endometrial Sentinel lymph node biopsy (FIRES) trial is the largest multicentre prospective study to date investigating the accuracy of SLND in multi-risk stage I patients. They concluded that their SLN algorithm presented high diagnostic accuracy with a much reduced false-negative rate of 3%(60). A further study directly compared SLND to LND(49). It reported reduced rates of readmission as well as decreased incidence of postoperative complications in the SLND group. In contrast, high grade and non-endometroid EC patients (confirmed on final histology) displayed failure in the mapping process(61). Overall, SLND has shown promising results in early-stage EC however, better recognition and adoption may aid optimisation of SLN algorithms(3,60).