Sentinel node technologies in low-resource settings: Current evidence and future perspectives

To review the role of sentinel lymph node (SLN) mapping in gynecologic oncology, with emphasis on its feasibility, challenges, and future perspectives in low- and middle-income countries (LMICs).

A narrative review of the literature was conducted, including prospective and retrospective trials, systematic reviews, international guidelines, and regional experiences in LMICs published between 2000 and 2025. The search was performed using PubMed, Scopus, and Web of Science.

SLN mapping provides accurate staging with reduced morbidity compared to systematic lymphadenectomy. Already known ultrastaging improves detection of micrometastases (MICs) and isolated tumor cells (ITCs), thereby refining nodal staging and prognostic stratification. Indocyanine green (ICG) demonstrates the highest detection rates, but its cost and the need for near-infrared imaging limit access in LMICs. Alternatives such as blue dyes, technetium-99 m, carbon nanoparticles, and superparamagnetic iron oxide (SPIO) offer variable performance and feasibility. Regional experiences from Latin America, Africa, and Asia confirm that simplified protocols, accessible tracers, and cooperative training programs enable safe and effective SLN implementation. Key obstacles include cost, tracer availability, lack of ultrastaging, surgical learning curves, and limited infrastructure. Emerging solutions involve portable fluorescence devices, SPIO, cost-effective carbon tracers, telepathology, and international mentoring.

SLN mapping represents a cornerstone of precision surgical staging in gynecologic oncology already known. In LMICs, its equitable implementation will depend on accessible tracers, portable fluorescence technologies, and sustained international collaboration, collectively advancing global health equity in cancer care.