Lymphatic Mapping for Endometrial Cancer

The staging for endometrial cancer is surgical and it should include both pelvic and para-aortic lymphadenectomy. The majority of endometrial cancers are diagnosed at early stage and lymphadenectomy gives no benefit for staging while adding surgical risks. Performing a systematic lymphadenectomy in very obese women is almost impossible. Preoperative lymphatic mapping (via planar lymphoscintigraphy, single photon emission computed tomography, or positron emission tomography) has poor correlation with surgical mapping of sentinel lymph nodes (SLNs), that has been proposed to avoid systematic lymphadenectomy in early stages. However, surgical SLN mapping is a very challenging procedure in endometrial cancer because the uterus has a complex lymphatic drainage. In the last 20 years, different authors used different tracers (vital stains, radioactive isotopes, or fluorescent dye), different sites of tracer injection (cervix, endometrium, or myometrium), and different surgical approaches (laparotomic, laparoscopic, or robotic) to find out the best procedure for SLNs identification. A well-designed, prospective, randomized, international multicenter tri¬al aimed at validating the accuracy of a uniform procedure is still lacking. In the meantime, to reduce the false-negative rate of intra-operative SLN mapping a surgical algorithm limits systematic pelvic lymphadenectomy to the hemi-pelvis without SLNs mapping and includes removal of any suspicious, although not mapped, node together with mapped SLNs.