The impact of cervical diameter on success of sentinel lymph node mapping in endometrial carcinoma: A retrospective cohort study

This study aimed to evaluate the effects of anatomical variation in cervical diameter and length on bilateral sentinel lymph node (SLN) mapping outcomes in endometrial carcinoma.

A retrospective cohort study was conducted including 341 patients with endometrial carcinoma who underwent SLN mapping from 2016 to 2019, via superficial and deep intracervical injection of indocyanine green at the 3' and 9' o'clock positions. Preoperative characteristics abstracted from chart review include BMI, age, and prior abdominal surgery. Peri- and postoperative collected characteristics included number of sentinel lymph nodes detected, cervix diameter and length, uterine weight and diameter, FIGO grade, estimated blood loss, operation length, and the American Society of Anesthesiologists (ASA) physical status classification.

Increased cervical diameter was independently associated with mapping failure (OR 2.13; 95 % CI, 1.27-3.58; p = 0.004) while variations in cervical length were not. Higher BMI and older age were also significantly associated with unsuccessful mapping.

Cervical diameter is an important variable predicting failure to map bilateral sentinel lymph nodes during surgical staging of endometrial carcinoma. Modification of injection techniques based on cervical diameter should be considered for investigation to improve SLN mapping outcomes.