OBJECTIVE: To explore the factors influencing adoption of the sentinel lymph node (SLN) technique for endometrial cancer staging among gynecologic oncologists. METHODS: A self-administered, web-based survey was sent via email (April 20 through May 21, 2017) to all members of European Society of Gynecologic Oncologists, International Gynecologic Cancer Society, and Society of Gynecologic Oncologists. Surgical and pathologic practices related to SLN and reasons for not adopting this technique were investigated. RESULTS: Overall, 489 attending physicians or consultants in gynecologic oncology from 69 countries responded: 201 (41.1%), 118 (24.1%), and 117 (23.9%) from Europe, the USA, and other countries, respectively (10.8% did not report a country). SLN was adopted by 246 (50.3%) respondents, with 93.1% injecting the cervix and 62.6 % using indocyanine green dye. The National Comprehensive Cancer Network SLN algorithm was followed by 160 (65.0%) respondents (USA 74.4%, Europe 55.4%, other countries 71.4%). However, 66.7% completed a backup lymphadenectomy in high-risk patients. When SLN biopsy revealed isolated tumor cells, 13.8% of respondents recommended adjuvant therapy. This percentage increased to 52% if micrometastases were detected. Among the 243 not adopting SLN, 50.2% cited lack of evidence and 45.3% stated that inadequate instrumentation fueled their decisions. CONCLUSIONS: SLN with a cervical injection is gaining widespread acceptance for staging of endometrial cancer among gynecologic oncologists worldwide. Standardization of the surgical approach with the National Comprehensive Care Network algorithm is applied by most users. Management of isolated tumor cells and the role of backup lymphadenectomy for 'high-risk' cases remain areas of investigation.

Department of Gynecologic Oncology and Reproductive Medicine Anderson Cancer Center Houston Texas USA

Department of Gynecology European Institute of Oncology Milan Italy

Department of Health Sciences Research Mayo Clinic Rochester Minnesota USA

Department of Obstetrics and Gynecology Asan Medical Center University of Ulsan Seoul Seoul Korea

Department of Obstetrics and Gynecology Mayo Clinic Rochester Minnesota USA

Department of Obstetrics and Gynecology University of Insubria Varese Italy

Department of Obstetrics and Gynecology Weill Cornell Medical Center New York City New York USA

Department of Surgery Division of Gynecology Memorial Sloan Kettering Cancer Center New York City New York USA

Departmentof Obstetrics and Gynecology Gynecologic Oncology Center 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Prague Czech Republic

Institut Begonié Cancer Center Bordeaux France

National Hospital Organization Kyoto Medical Center Kyoto Japan

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A prospective multicenter international single-arm observational study on the oncological safety of the sentinel lymph node algorithm in stage I intermediate-risk endometrial cancer (SELECT, SEntinel Lymph node Endometrial Cancer Trial)