The Impact of Body Mass Index on Sentinel Lymph Node Identification in Endometrial Cancer

Endometrial cancer, a prevalent gynecologic malignancy, is often associated with obesity. Sentinel lymph node (SLN) mapping, a minimally invasive staging method, reduces the need for extensive lymphadenectomy, thereby minimizing surgical morbidity. However, the influence of body mass index (BMI) on SLN mapping outcomes is not fully understood. This study evaluated the relationship between BMI and SLN mapping success using data from a large and diverse patient cohort.

A retrospective study of 112 patients diagnosed with endometrial carcinoma was conducted. Patients were categorized into non-obesity (BMI <30 kg/m²) and obesity (≥30 kg/m²) groups. All underwent laparoscopic hysterectomy with SLN mapping using indocyanine green (ICG) dye. Statistical analysis was performed using univariable and multivariable logistic regression models.

LN detection rates were 77.7% overall, with bilateral mapping achieved in 54.5% of patients. Mapping success was higher in the non-obesity group (59.7%) compared to the obesity group (49.1%; p=0.099). Mapping failure rates were notably higher in obese patients (30.9%) versus non-obese patients (14.0%) (p=0.099). Multivariable logistic regression analysis identified advanced cancer stage as a significant predictor of SLN biopsy positivity (adjusted odds ratio=30.2, p=0.002).

Obesity negatively impacts the technical success of SLN mapping in endometrial cancer, with lower bilateral detection rates and higher mapping failures observed in obese patients. These findings underscore the need for surgical strategies tailored to obese patients, such as optimizing tracer injection techniques, utilizing advanced imaging technologies, and incorporating preoperative planning to account for anatomical challenges. Addressing these factors may enhance SLN detection and improve staging accuracy in this high-risk population.