Introduction/Background Despite the prospective validation of sentinel lymph node (SLN) biopsy in early-stage endometrial cancer, there remains a lack of evidence regarding the oncological outcomes associated with the SLN procedure alone. Our study aimed to determine the disease-free survival (DFS) in low-risk endometrial cancer patients undergoing exclusive SLN procedures and validate the efficacy of this approach in high-risk patients, irrespective of the surgical approach, within an Indian patient population.

Methodology We prospectively enrolled patients with uterine-confined endometrial cancer, regardless of histology or risk factors, who underwent surgery via laparoscopy, robotic-assisted, or open laparotomy approaches at Tata Medical Centre, Kolkata, India, between December 2019 and November 2021. All patients received indocyanine green (ICG) dye injections for SLN mapping. We analysed patient and disease characteristics, as well as survival outcomes, with a specific focus on low-risk patients.

Results Among the 143 women enrolled, 98 (68.5%) underwent SLN biopsy along with pelvic lymphadenectomy, while 45 patients with low-risk disease underwent SLN biopsy alone. Within the low-risk group, 4 patients (8.9%) had positive SLNs. With a median follow-up of 20 months (range: 1–40 months), all patients remained disease-free. For high-risk patients, the SLN detection rates per patient were 98.6% (95% CI: 95%–99.6%), with a bilateral detection rate of 88.1% (95% CI: 81.8%–92.4%). The SLN-ICG algorithm demonstrated an overall sensitivity of 74% (95% CI: 48.8%–90.9%), while the robotic SLN algorithm exhibited a sensitivity of 80% (95% CI: 44.4%–96.7%) and a negative predictive value of 96% (95% CI: 86.8%–99.5%).

Conclusion Our prospective study provides valuable insights, showing that the SLN procedure alone has a good oncological outcome, though our follow-up duration was low. Additionally, the SLN-ICG and robotic SLN algorithms demonstrate good sensitivity and negative predictive value, supporting their efficacy in guiding surgical management.

Disclosures No conflict of interest