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Updated: May 15, 2026
Sentinel Lymph Node Mapping and Biopsy for Endometrial Cancer at Early Stage with Laparoscopy
Published on: August 19, 2021
Prognostic value of the SENTIREC-endo algorithm integrating sentinel lymph node and FDG-PET/CT in staging high-risk
Jorun Holm1, Sarah Marie Bjørnholt2, Oke Gerke1
1Department of Nuclear Medicine, Odense University Hospital, 5000, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, 5230, Odense, Denmark.
Introduction:
Lymph node metastasis is a significant negative prognostic factor in women with high-risk endometrial cancer. The SENTIREC-endo algorithm, combining sentinel lymph node mapping and FDG-PET/CT for targeted pelvic and paraaortic lymph node dissection has shown high diagnostic accuracy. This study investigated whether the SENTIREC-endo algorithm showed similar prognostic discrimination to systematic lymphadenectomy within the same cohort.
Methods:
In a prospective national non-randomized cohort (2017-2023), women with high-risk endometrial cancer underwent the SENTIREC-endo algorithm, including sentinel node mapping, resection of suspicious and/or FDG-PET-positive nodes, followed by systematic lymph node dissection. Within the cohort, we compared time to progression and mortality between node-positive and node-negative groups, as defined by the algorithm versus systematic dissection. We also assessed the prognostic value and diagnostic accuracy of lymphovascular space invasion (LVSI) and evaluated associated prognostic variables.
Results:
The SENTIREC-endo algorithm demonstrated significant discrimination in survival outcomes (p = 0.001), with Kaplan-Meier curves paralleling systematic lymphadenectomy, supporting its prognostic performance. LVSI showed a strong prognostic association (p = 0.0004) but low sensitivity for detection of nodal metastasis (38%, 95% CI 24-54%), suggesting prognostic independence from lymph node status. FDG-PET/CT combined with LVSI lacked sufficient prognostic accuracy to replace surgical staging.
Conclusion:
The SENTIREC-endo algorithm showed similar prognostic discrimination as systematic lymphadenectomy within the same cohort of high-risk endometrial cancer. LVSI remained an essential prognostic marker but was unsuitable for predicting nodal metastasis. Our findings support surgical lymph node dissection with validated targeted dissection should remain part of standard staging of women with high-risk endometrial cancer.
