Lymphatic mapping in endometrial cancer: a literature review of current techniques and results

The objective of this study was to review available literature pertaining to lymphatic mapping in endometrial cancer. We reviewed all published series of lymphatic mapping in endometrial cancer available through a PubMed search. Techniques used for identification of sentinel lymph nodes fell into three main categories in relation to the site of injection: 1) uterine subserosal, 2) cervical, and 3) endometrial via hysteroscopy. High detection rates may be achieved in all three categories. The use of both radiolabeled technetium and blue dye has been reported. A combination of cervical and uterine corpus injections appears feasible and less technically demanding than hysteroscopic injections. Immunohistochemistry staining of sentinel nodes coupled with step-serial section may improve the detection of micrometastasis in sentinel nodes. Meaningful sensitivity and false-negative rates cannot be calculated from current series due to their small numbers. The role of lymphatic mapping in endometrial carcinoma and the optimal injection site remains to be determined. A combination of cervical and uterine fundal injections may result in acceptable detection rates. Large-scale validation trials requiring complete pelvic and para-aortic lymphadenectomy are needed to evaluate its role in future clinical practice.