Introduction Different practice regarding management of endometrial carcinoma has been observed over the world. British Gynaecological Cancer Society recommends a total hysterectomy and bilateral salpingo-oophorectomy without lymphadenectomy in women with presumed low risk disease. The European Society of Gynaecological Oncology recommended sentinel lymph node biopsy to be considered for staging purposes in patients with low-risk disease or high-risk disease.

Methods A retrospective cohort study, of all Endometrial Carcinoma treated in University Hospital Waterford between December 2020 and September 2023, was performed. In our review we looked at the role of using the referral histology and MRI in predicting lymph nodes involvement.

Results In our study, 34 patients had low-grade EEC, all of them had LN assessment during definitive surgery. positive LN were found in 7 patients (20.5%). Of the 17 high-risk endometrial sample, 4 patients had positive LN (23.5%). We did not find MRI useful for triaging cases at presentation for surgical lymph node assessment. 3 out of 20 patients who had low grade endometrial sample and myometrial invasion <50% had positive LN with overall risk of 15%. A sizable number of patients, 8 of 31 patients (25.8%) with myometrial invasion <50% on MRI had greater than 50% on pathology.

Conclusion/Implications Lymph node assessment is recommended in all endometrial carcinoma patients irrespective of the histological type, grade or MRI findings. Given the high sensitivity and negative predictive value with SLN mapping, SLNB may replace routine lymphadenectomy in surgical staging of endometrial cancers.