Sentinel Lymph Node Mapping in Patients with Endometrial Carcinoma: Less Can Be More

The role and extent of lymphadenectomy for endometrial carcinoma has been debated for over 30 years. Many clinicians argue that there is therapeutic value for lymphadenectomy in patients deemed to be "at risk", a designation not universally defined, despite the lack of randomized data supporting this argument. However, lymphadenectomy is associated with morbidity, including lower extremity lymphedema. Sentinel lymph node (SLN) mapping is emerging as a viable alternative to comprehensive lymphadenectomy in the surgical staging of patients with endometrial cancer.

Nodal disease status is an important prognostic and predictive factor. Surgical staging with lymphadenectomy remains an important part of the treatment of patients with newly diagnosed endometrial carcinoma despite the dispute regarding its therapeutic value. Many clinicians have argued for abandoning lymphadenectomy altogether; however, this too is not ideal, as it may lead to under-treatment due to inadequate staging or over-treatment with toxic therapies.

SLN mapping has emerged as a viable compromise between a comprehensive lymphadenectomy and no lymph node sampling in the surgical staging of these patients, and may lead to reduced morbidity risks. In this review, we present the currently available data in this area of research, as well as our experience with SLN mapping.