Sentinel Lymph Node Mapping in Endometrial Cancer in the Molecular Era: Current Evidence, Clinical Controversies, and Unresolved Questions.

Authors

Raffaele Tinelli, Felice Sorrentino, Daniela Surico, Alessandro Messina, Stefano Angioni, Giorgio Bogani, Carmen Imma Aquino, Michele Peiretti, Alessandro Libretti

Published in

Journal of clinical medicine. Volume 15. Issue 21. Nov 07, 2026. Epub Nov 07, 2026.

Abstract

Sentinel lymph node (SLN) mapping is an established approach to nodal staging in presumed uterine-confined endometrial cancer, but its integration with molecular risk assessment raises unresolved clinical questions. This narrative review examines tracer and injection-site selection, persistent mapping failure, high-risk histologies, para-aortic assessment, low-volume nodal disease, and interpretation across POLEmut, MMRd, NSMP and p53abn tumors. A focused literature update and bibliographic verification were performed in October 2026. Cervical indocyanine green injection with near-infrared imaging supports reproducible pelvic mapping; comparative tracer studies favor it over blue dye. Prospective high-risk cohorts demonstrate high diagnostic accuracy when a complete algorithm is applied, but do not establish survival non-inferiority within every histologic or molecular subgroup. An unmapped hemipelvis requires technical reassessment and management according to baseline staging indication and operative feasibility. Negative pelvic SLNs do not exclude all para-aortic disease; additional assessment should address a defined treatment-planning question. Micrometastases constitute nodal metastasis, whereas isolated tumor cells are reported as pN0(i+). Molecularly annotated cohorts refine prognostic interpretation, but do not validate subgroup-specific treatment rules for low-volume disease. Future trials should evaluate treatment changes, morbidity and oncologic outcomes, rather than detection alone. The review distinguishes current staging practice from prognostic observations and hypotheses requiring prospective validation.

PMID:
43030832
Bibliographic data and abstract were imported from PubMed on 14 Nov 2026.

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