Sentinel Lymph Node Assessment in Endometrial Intraepithelial Neoplasia/Atypical Endometrial Hyperplasia: An Updated Systematic Review and Meta-Analysis.
- 1Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan.
- 2Department of Obstetrics and Gynecology, Tainan Sin-Lau Hospital, Tainan 701, Taiwan.
- 3Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan.
Abstract
Background/Objectives: Endometrial intraepithelial neoplasia (EIN)/atypical endometrial hyperplasia (AEH) carries a substantial risk of concurrent endometrial carcinoma; however, the role of sentinel lymph node (SLN) assessment during hysterectomy remains controversial. We performed an updated systematic review and meta-analysis to quantify concurrent carcinoma and evaluate SLN/nodal outcomes in women with preoperative EIN/AEH. Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies reporting concurrent carcinoma and/or SLN/nodal outcomes in women with preoperative EIN/AEH undergoing hysterectomy. Proportions were pooled using a random-effects DerSimonian-Laird model with Freeman-Tukey double-arcsine transformation, with subgroup analyses by histological terminology. Risk of bias was assessed using the QUIPS tool. Results: Nineteen studies, including 13,553 women, were included; 14 studies comprising 1174 women contributed to the pooled nodal-positivity estimate. The pooled rate of concurrent carcinoma was 39.6% (95% CI 34.9-44.3; I² = 86%), with rates of 43.8% in AEH/atypical hyperplasia cohorts and 33.4% in EIN cohorts. Pooled nodal positivity was 3.0% (95% CI 2.1-4.0; I² = 0%) and was predominantly low-volume disease. The pooled bilateral SLN detection rate was 71.6% (95% CI 67.3-75.7), and SLN was not associated with excess surgical complications. SLN findings influenced adjuvant treatment decisions in a minority of patients. Conclusion: Concurrent carcinoma occurs in approximately two in five women with preoperative EIN/AEH, whereas nodal metastasis is uncommon and generally low-volume. SLN mapping appears feasible and may inform adjuvant management in selected patients. However, because this estimate was derived largely from patients already selected for higher-risk features, it does not, by itself, establish that risk-based selection would substantially outperform routine assessment. Taken together with preliminary prospective data, it is more appropriately viewed as hypothesis-generating support for a selective, risk-stratified approach, pending larger prospective validation.
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BibTeX
@article{li2026sentinel,
title = {{Sentinel Lymph Node Assessment in Endometrial Intraepithelial Neoplasia/Atypical Endometrial Hyperplasia: An Updated Systematic Review and Meta-Analysis.}},
author = {Pei-Chen Li and Dah-Ching Ding},
journal = {Diagnostics (Basel, Switzerland)},
year = {2026},
month = sep,
doi = {10.3390/diagnostics16193114},
url = {https://europepmc.org/article/MED/42882269},
note = {CC BY},
}
RIS
TY - JOUR
TI - Sentinel Lymph Node Assessment in Endometrial Intraepithelial Neoplasia/Atypical Endometrial Hyperplasia: An Updated Systematic Review and Meta-Analysis.
AU - Pei-Chen Li
AU - Dah-Ching Ding
PY - 2026
DA - 2026/09/25
JO - Diagnostics (Basel, Switzerland)
DO - 10.3390/diagnostics16193114
UR - https://europepmc.org/article/MED/42882269
AB - Background/Objectives: Endometrial intraepithelial neoplasia (EIN)/atypical endometrial hyperplasia (AEH) carries a substantial risk of concurrent endometrial carcinoma; however, the role of sentinel lymph node (SLN) assessment during hysterectomy remains controversial. We performed an updated systematic review and meta-analysis to quantify concurrent carcinoma and evaluate SLN/nodal outcomes in women with preoperative EIN/AEH. Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies reporting concurrent carcinoma and/or SLN/nodal outcomes in women with preoperative EIN/AEH undergoing hysterectomy. Proportions were pooled using a random-effects DerSimonian-Laird model with Freeman-Tukey double-arcsine transformation, with subgroup analyses by histological terminology. Risk of bias was assessed using the QUIPS tool. Results: Nineteen studies, including 13,553 women, were included; 14 studies comprising 1174 women contributed to the pooled nodal-positivity estimate. The pooled rate of concurrent carcinoma was 39.6% (95% CI 34.9-44.3; I² = 86%), with rates of 43.8% in AEH/atypical hyperplasia cohorts and 33.4% in EIN cohorts. Pooled nodal positivity was 3.0% (95% CI 2.1-4.0; I² = 0%) and was predominantly low-volume disease. The pooled bilateral SLN detection rate was 71.6% (95% CI 67.3-75.7), and SLN was not associated with excess surgical complications. SLN findings influenced adjuvant treatment decisions in a minority of patients. Conclusion: Concurrent carcinoma occurs in approximately two in five women with preoperative EIN/AEH, whereas nodal metastasis is uncommon and generally low-volume. SLN mapping appears feasible and may inform adjuvant management in selected patients. However, because this estimate was derived largely from patients already selected for higher-risk features, it does not, by itself, establish that risk-based selection would substantially outperform routine assessment. Taken together with preliminary prospective data, it is more appropriately viewed as hypothesis-generating support for a selective, risk-stratified approach, pending larger prospective validation.
SN - 2075-4418
ER -