The Assessment of Sentinel Lymph Node Mapping Methods in Endometrial Cancer

Background/Objectives: Sentinel lymph node biopsy (SLNB) is a minimally invasive technique used to assess lymphatic involvement in endometrial cancer (EC), offering reduced surgical morbidity compared to routine lymphadenectomy. Despite its widespread use, the optimal combination of tracers for SLN detection remains a subject of debate. Methods: This retrospective cohort study included 119 patients with early-stage EC treated at the Maria Skłodowska-Curie National Research Institute of Oncology between 2016 and 2021. SLNB was performed using technetium-99m (Tc99m), indocyanine green (ICG), Patent Blue, or combinations of these tracers. Detection rates for unilateral and bilateral SLNs and the accuracy of metastasis identification were analyzed. Results: The overall SLN detection rate was 97.5%. Individual tracer detection rates were 100% for ICG, 100% for Patent Blue, and 96% for Tc99m. Combined tracers achieved detection rates of 96.9% (Tc99m and ICG) and 97.3% (Tc99m and Patent Blue). Bilateral detection was highest with Tc99m and ICG (90.6%) and Patent Blue alone (91%). Metastases were identified in 12% of cases, with combined methods improving metastatic detection. Tc99m yielded no "empty nodes", compared to 1.7% with Patent Blue and 0.8% with ICG. Conclusions: While combining Tc99m with dyes did not significantly improve overall SLN detection rates, it enhanced metastatic identification and reduced false-negative results. These findings suggest that combined tracer methods optimize SLNB accuracy in endometrial cancer. Prospective studies are needed to confirm these results.