Introduction Sentinel lymph node (SLN) mapping is suggested to be a safe staging method for women with high-risk endometrial cancer (EC). However, approximately 20–45% of women have failed mapping, leaving a need for consensus on the choice of the surgical algorithm in case of non-mapping. We aimed to assess the safety of SLN-mapping algorithms in women with high-risk EC.
Methods We undertook a national prospective diagnostic accuracy study of SLN-mapping in women with high-risk EC from March 2017- January 2023. A power calculation was based on the negative predictive value (NPV). Women underwent SLN-mapping, pelvic (PLD) and paraaortic (PALND) lymph node dissection besides removal of any FDG/PET-positive lymph nodes.
Results We included 216 women; 170 women underwent SLN mapping, PLD and PALND and were included in the analyses. 42/170 (24.7%) had nodal metastasis. The algorithm SLN+PLD in case of failed mapping demonstrated a sensitivity of 88% (95% CI 74–96) and an NPV of 96% (95% CI 91–99). The sensitivity increased to 93% (95% CI 81–99) and the NPV to 98% (95% CI 93–100) if PLD was combined with removal of any PET-positive lymph nodes regardless of mapping. PLD+PALND in non-mapping cases achieved a sensitivity of 95% (95% CI 84–99), NPV 98% (95% CI 95–100).
Conclusion/Implications SLN-mapping is a safe staging procedure in women with high-risk EC if strictly adhering to a surgical algorithm, including removal of any PET-positive lymph nodes independent of location and PLD in failed mapping cases. PLD+PALND obtain similar accuracy in case of failed mapping if FDG/PET-CT is not available.
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