Predictors of Bilateral Sentinel Lymph Node Mapping Failure in Endometrial Cancer: A Systematic Review and...

Area of Science:

• Gynecologic Oncology
• Surgical Pathology
• Medical Imaging

Background:

• Sentinel lymph node (SLN) mapping is crucial for staging early-stage endometrial cancer.
• Minimally invasive surgery with indocyanine green (ICG) fluorescence imaging is increasingly used for SLN mapping.
• Predictors of bilateral SLN mapping failure require identification to optimize surgical planning.

Purpose of the Study:

• To identify clinicopathological and procedural predictors of bilateral sentinel lymph node (SLN) mapping failure.
• To analyze factors associated with SLN mapping success in early-stage endometrial cancer patients undergoing minimally invasive surgery with ICG fluorescence imaging.

Main Methods:

• Systematic literature search of PubMed, EMBASE, and Cochrane Central Register of Controlled Trials.
• Inclusion of observational studies predominantly involving patients with early-stage endometrial cancer undergoing cervical ICG-based SLN mapping.
• Random-effects meta-analysis of data from 16 studies comprising 6,977 patients.

Main Results:

• Obesity (BMI ≥30 kg/m²), high tumor grade (G3), non-endometrioid histology, and lymph node involvement significantly increased the risk of bilateral SLN mapping failure.
• Age, prior pelvic surgery, tumor size, cervical involvement, FIGO stage, lymphovascular space invasion, and surgical approach were not significantly associated with mapping outcomes.
• Sensitivity analyses confirmed the robustness of the findings, with assessed heterogeneity using the I² statistic.

Conclusions:

• Bilateral SLN mapping failure in endometrial cancer is primarily driven by patient- and tumor-related factors.
• Surgical approach was not significantly associated with SLN mapping outcomes.
• Identifying high-risk patients can facilitate individualized surgical planning and intraoperative decision-making.