Introduction/Background Sentinel lymph node (SLN) biopsy is an alternative staging approach in women with early-stage endometrial carcinoma. The SLN approach is introducing ‘precision medicine’ to the surgical management of gynaecological cancers, providing a comprehensive evaluation of high-yield lymph nodes. This approach improves our ability to detect small-volume metastatic disease whilst reducing intra-operative and post-operative morbidity associated with systematic lymphadenectomy. Although the majority of clinicians in Europe/USA have recognised the value of SLN biopsy in endometrial carcinoma and introduced this as part of clinical practice, there is ongoing debate regarding its role in very low-risk patients and patients at high risk of nodal metastasis. The significance of low-volume metastasis is not fully understood, and there is no consensus in regard to how the presence of isolated tumour cells should guide adjuvant therapy.

Methodology We present a case of a forty-seven year old woman presenting with grade III, radiological stage IIICI endometrioid endometrial carcinoma. A pre-operative MRI have revealed a suspicious 9 mm left external iliac lymph node. She underwent a total laparoscopic hysterectomy, right sentinel lymph node biopsy and systematic left pelvic lymph node dissection.

Results Final histopathology revealed a grade III, stage IA endometrioid endometrial carcinoma, ER+, P53 wild type, MMR proficient. She underwent an uneventful post-operative recovery. Following counselling, she declined vault brachytherapy.

Conclusion SLN biopsy is increasingly used as an alternative to systematic lymphadenectomy in surgical staging in endometrial carcinoma, has gained significant acceptance and is applied in many centres. Robust data exists regarding the accuracy of SLN biopsy for nodal staging in all risk-categories of endometrial carcinoma, but prospective data on oncological outcomes are lacking.