Sentinel Lymph Node Mapping in Endometrial Cancer in the Molecular Era: Current Evidence, Clinical Controversies, and Unresolved Questions
6 affiliations
- 1Department of Obstetrics and Gynecology, “Valle d’Itria” Hospital, 74015 Martina Franca, Italy
- 2Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71122 Foggia, Italy
- 3Department of Gynaecology and Obstetrics, University Hospital Maggiore Della Carità, Corso Mazzini, 18, 28100 Novara, Italy
- 4Department of Obstetrics and Gynecology, University Hospital “Degli Infermi”, 13875 Ponderano, Italy
- 5Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
- 6Gynecologic Oncologic Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
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.
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BibTeX
@article{tinelli2026sentinel,
title = {{Sentinel Lymph Node Mapping in Endometrial Cancer in the Molecular Era: Current Evidence, Clinical Controversies, and Unresolved Questions}},
author = {Raffaele Tinelli and Felice Sorrentino and Daniela Surico and Alessandro Messina and Stefano Angioni and Giorgio Bogani and Carmen Imma Aquino and Michele Peiretti and Alessandro Libretti},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218690},
url = {https://www.mdpi.com/2077-0383/15/21/8690},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Sentinel Lymph Node Mapping in Endometrial Cancer in the Molecular Era: Current Evidence, Clinical Controversies, and Unresolved Questions
AU - Raffaele Tinelli
AU - Felice Sorrentino
AU - Daniela Surico
AU - Alessandro Messina
AU - Stefano Angioni
AU - Giorgio Bogani
AU - Carmen Imma Aquino
AU - Michele Peiretti
AU - Alessandro Libretti
PY - 2026
DA - 2026/11/07
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218690
UR - https://www.mdpi.com/2077-0383/15/21/8690
AB - 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.
SN - 2077-0383
ER -