BACKGROUND: This study aimed to evaluate the effectiveness of different tracers´ application techniques for sentinel lymph node (SLN) detection in women with endometrial cancer undergoing laparotomy. Additionally, potential risk factors for SLN detection failure were assessed. METHODS: We retrospectively analyzed data from 248 endometrial cancer patients who underwent abdominal surgery with SLN mapping between January 2020 and March 2024. Statistical analyses were conducted using the Wilcoxon rank sum test for continuous variables and either Pearson's chi-square test or Fisher's exact test for categorical variables, with a significance level set at p < 0.05. RESULTS: Group I + S consisted of 147 women with intracervical and subserosal tracers´application and group I + I included 101 women with intracervical and intrafundal application. Successful detection of SLN on both sides was achieved in 39.9% (99/248) of all patients, in 38.1% (56/147) in the I + S group and in 42.6% (43/101) in the I + I group, respectively. SLNs were identified in 32.7% (81/248) of all patients on only one side of the pelvis, in 31.3% (46/147) in the I + S and in 34.7% (35/101) in the I + I group, respectively. No SLNs were detected in 27.4% (68/248) of all subjects, comprising 30.6% (45/147) from the I + S and 22.8% (23/101) from the I + I group. Although the success rate of SLN detection was higher in the I + I group and on the right side of the pelvis regardless of the detection method, these differences were not statistically significant. An age exceeding 66.3 years was recognized as a critical risk factor for successful detection, other followed factors did not demonstrate a statistically significant impact on overall detection success. Additional significant risk factors were identified: depth of tumor myometrial invasion on the right side, history of pelvic surgery, and total tumor volume on the left side. CONCLUSIONS: The study did not reveal significant differences in SLN mapping success between the groups receiving intracervical + intrafundal and intracervical + subserosal tracers´applications among endometrial cancer patients treated via open surgery. Overall, older age emerged as the most critical risk factor for SLN detection failure, while other assessed factors did not show a statistically significant impact on overall detection success. TRIAL REGISTRATION: Institution University Hospital Královské Vinohrady, Prague, Czech Republic. REGISTRATION NUMBER: EK-VP-21-0-2023. Date of registration 7-JUN-2023. This study was retrospectively registered in compliance with the Declaration of Helsinki.

Department of Anaesthesia and Intensive Care Medicine University Hospital Kralovske Vinohrady and 3rd Faculty of Medicine Charles University Srobarova 1150 50 Prague 10 100 34 Czech Republic

Department of Obstetrics and Gynaecology University Hospital Kralovske Vinohrady and 3rd Faculty of Medicine Charles University Srobarova 1150 50 Prague 10 100 34 Czech Republic

Department of Obstetrics and Gynecology 3rd Faculty of Medicine Faculty Hospital Kralovske Vinohrady Charles University Srobarova 1150 50 Prague 10 100 34 Czech Republic

Department of Pathology University Hospital Kralovske Vinohrady and 3rd Faculty of Medicine Charles University Srobarova 1150 50 Prague 10 100 34 Czech Republic

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Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229–63. PubMed

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49. PubMed

Sant M, Chirlaque Lopez MD, Agresti R, Sánchez Pérez MJ, Holleczek B, Bielska-Lasota M, et al. Survival of women with cancers of breast and genital organs in Europe 1999–2007: results of the EUROCARE-5 study. Eur J Cancer Oxf Engl 1990. 2015;51(15):2191–205. PubMed

Abu-Rustum N, Yashar C, Arend R, Barber E, Bradley K, Brooks R, et al. Uterine neoplasms, version 1.2023, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw JNCCN. 2023;21(2):181–209. PubMed

Concin N, Matias-Guiu X, Vergote I, Cibula D, Mirza MR, Marnitz S, et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Radiother Oncol J Eur Soc Ther Radiol Oncol. 2021;154:327–53. PubMed

Holloway RW, Abu-Rustum NR, Backes FJ, Boggess JF, Gotlieb WH, Jeffrey Lowery W, et al. Sentinel lymph node mapping and staging in endometrial cancer: A society of gynecologic oncology literature review with consensus recommendations. Gynecol Oncol. 2017;146(2):405–15. PubMed PMC

R: The R Project for Statistical Computing [Internet]. [cited 2024 Oct 4]. Available from: https://www.r-project.org/

Friedman J, Hastie T, Tibshirani R. Regularization paths for generalized linear models via coordinate descent. J Stat Softw. 2010;33(1):1–22. PubMed PMC

Tay JK, Narasimhan B, Hastie T. Elastic net regularization paths for all generalized linear models. J Stat Softw. 2023;106:1. PubMed PMC

Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3(1):32–5. PubMed

Salman L, Cusimano MC, Marchocki Z, Ferguson SE. Sentinel lymph node mapping in endometrial cancer: current evidence and practice. J Surg Oncol. 2024;129(1):117–9. PubMed

Leitao MM, Zhou QC, Gomez-Hidalgo NR, Iasonos A, Baser R, Mezzancello M, et al. Patient-reported outcomes after surgery for endometrial carcinoma: prevalence of lower-extremity lymphedema after Sentinel lymph node mapping versus lymphadenectomy. Gynecol Oncol. 2020;156(1):147–53. PubMed PMC

Vinklerová P, Minář L, Weinberger V, Felsinger M, Koblížková M. Change in the trend of surgical treatment and staging of lymph nodes in endometrial cancer - results of the oncogynecology center, department of gynecology and obstetrics, university hospital Brno and Masaryk university in the years 2012–2021. Ceska Gynekol. 2022;87(5):308–16. PubMed

Terada S, Tanaka T, Murakami H, Tsuchihashi H, Toji A, Daimon A, et al. Lymphatic complications following Sentinel node biopsy or pelvic lymphadenectomy for endometrial cancer. J Clin Med. 2023;12(13):4540. PubMed PMC

Janda M, Gebski V, Davies LC, Forder P, Brand A, Hogg R, et al. Effect of total laparoscopic hysterectomy vs total abdominal hysterectomy on Disease-Free survival among women with stage I endometrial cancer: A randomized clinical trial. JAMA. 2017;317(12):1224–33. PubMed

Sanjida S, Obermair A, Gebski V, Armfield N, Janda M. Long-term quality of life outcomes of women treated for early-stage endometrial cancer. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2021;31(4):530–6. PubMed

Galaal K, Bryant A, Fisher AD, Al-Khaduri M, Kew F, Lopes AD. Laparoscopy versus laparotomy for the management of early stage endometrial cancer. Cochrane Database Syst Rev. 2012;(9):CD006655. PubMed

Cusimano MC, Simpson AN, Dossa F, Liani V, Kaur Y, Acuna SA, et al. Laparoscopic and robotic hysterectomy in endometrial cancer patients with obesity: a systematic review and meta-analysis of conversions and complications. Am J Obstet Gynecol. 2019;221(5):410–e42819. PubMed

Segarra-Vidal B, Dinoi G, Zorrilla-Vaca A, Mariani A, Student V, Garcia NA, et al. Minimally invasive compared with open hysterectomy in High-Risk endometrial cancer. Obstet Gynecol. 2021;138(6):828–37. PubMed

Altın D, Taşkın S, Ortaç F, Tokgözoğlu N, Vatansever D, Güler AH, et al. Diagnostic accuracy of Sentinel node biopsy in non-endometrioid, high-grade and/or deep myoinvasive endometrial cancer: A Turkish gynecologic oncology group study (TRSGO-SLN-006). Gynecol Oncol. 2022;164(3):492–7. PubMed

Gezer Ş, Duman Öztürk S, Hekimsoy T, Vural Ç, İşgören S, Yücesoy İ, et al. Cervical versus endometrial injection for Sentinel lymph node detection in endometrial cancer: a randomized clinical trial. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2020;30(3):325–31. PubMed

Jankulovska A, Stojcevski S, Aluloski I, Tanturovski M, Manevska N, Markova AD, et al. Predictors of bilateral SLN radiocolloid detection in endometrial carcinoma. World J Nucl Med. 2023;22(4):261–6. PubMed PMC

Emons G, Steiner E, Vordermark D, Uleer C, Paradies K, Tempfer C et al. September. Endometrial Cancer. Guideline of the DGGG, DKG and DKH (S3-Level, AWMF Registry Number 032/034-OL, 2022). Part 1 with Recommendations on the Epidemiology, Screening, Diagnosis and Hereditary Factors of Endometrial Cancer, Geriatric Assessment and Supply Structures. Geburtshilfe Frauenheilkd. 2023;83(8):919–62. PubMed PMC

Fotopoulou C, Ind T, Baldwin P, Crawford R, Devaja O, Dobbs S, et al. Sentinel lymph node consensus document of the British gynaecological cancer society for endometrial, vulvar, and cervical cancers. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2019;29(9):1348–50. PubMed

Dick A, Perri T, Kogan L, Brandt B, Meyer R, Levin G. Sentinel lymph node mapping in endometrial cancer: A comparison of main National and international guidelines. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2023;160(1):220–5. PubMed PMC

Dioun S, Chen L, Melamed A, Gockley A, St Clair CM, Hou JY, et al. Uptake and outcomes of Sentinel lymph node mapping in women undergoing minimally invasive surgery for endometrial cancer. BJOG Int J Obstet Gynaecol. 2022;129(9):1591–9. PubMed

Matsuo K, Klar M, Nusbaum DJ, Hasanov MF, Vallejo A, Ciesielski KM, et al. Utilization and outcomes of Sentinel lymph node biopsy for early endometrial cancer. Obstet Gynecol. 2022;139(5):809–20. PubMed

Malikova H, Nadova K, Reginacova K, Kremenova K, Rob L. Radiation-Related fractures after radical radiotherapy for cervical and endometrial cancers: are there any differences?? Diagn Basel Switz. 2024;14(8):810. PubMed PMC

Rossi EC, Jackson A, Ivanova A, Boggess JF. Detection of Sentinel nodes for endometrial cancer with robotic assisted fluorescence imaging: cervical versus hysteroscopic injection. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2013;23(9):1704–11. PubMed

Niikura H, Kaiho-Sakuma M, Tokunaga H, Toyoshima M, Utsunomiya H, Nagase S, et al. Tracer injection sites and combinations for Sentinel lymph node detection in patients with endometrial cancer. Gynecol Oncol. 2013;131(2):299–303. PubMed

Geppert B, Lönnerfors C, Bollino M, Arechvo A, Persson J. A study on uterine lymphatic anatomy for standardization of pelvic Sentinel lymph node detection in endometrial cancer. Gynecol Oncol. 2017;145(2):256–61. PubMed

Zuo J, Wu LY, Cheng M, Bai P, Lei CZ, Li N, et al. Comparison study of laparoscopic Sentinel lymph node mapping in endometrial carcinoma using carbon nanoparticles and lymphatic pathway verification. J Minim Invasive Gynecol. 2019;26(6):1125–32. PubMed

Ditto A, Casarin I, Pinelli C, Perrone AM, Scollo P, Martinelli F, et al. Hysteroscopic versus cervical injection for Sentinel node detection in endometrial cancer: A multicenter prospective randomised controlled trial from the multicenter Italian trials in ovarian cancer (MITO) study group. Eur J Cancer Oxf Engl 1990. 2020;140:1–10. PubMed

Perrone AM, Casadio P, Formelli G, Levorato M, Ghi T, Costa S, et al. Cervical and hysteroscopic injection for identification of Sentinel lymph node in endometrial cancer. Gynecol Oncol. 2008;111(1):62–7. PubMed

Robova H, Charvat M, Strnad P, Hrehorcak M, Taborska K, Skapa P, et al. Lymphatic mapping in endometrial cancer: comparison of hysteroscopic and subserosal injection and the distribution of Sentinel lymph nodes. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2009;19(3):391–4. PubMed

Sawicki S, Lass P, Wydra D. Sentinel lymph node biopsy in endometrial Cancer–Comparison of 2 detection methods. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2015;25(6):1044–50. PubMed

Fan MS, Qiu KX, Wang DY, Wang H, Zhang WW, Yan L. Risk factors associated with false negative rate of Sentinel lymph node biopsy in endometrial cancer: a systematic review and meta-analysis. Front Oncol. 2024;14:1391267. PubMed PMC

Bodurtha Smith AJ, Fader AN, Tanner EJ. Sentinel lymph node assessment in endometrial cancer: a systematic review and meta-analysis. Am J Obstet Gynecol. 2017;216(5):459–e47610. PubMed

Cormier B, Rozenholc AT, Gotlieb W, Plante M, Giede C. Communities of practice (CoP) group of society of gynecologic oncology of Canada (GOC). Sentinel lymph node procedure in endometrial cancer: A systematic review and proposal for standardization of future research. Gynecol Oncol. 2015;138(2):478–85. PubMed

Nagar H, Wietek N, Goodall RJ, Hughes W, Schmidt-Hansen M, Morrison J. Sentinel node biopsy for diagnosis of lymph node involvement in endometrial cancer. Cochrane Database Syst Rev. 2021;6(6):CD013021. PubMed PMC

Accorsi GS, Paiva LL, Schmidt R, Vieira M, Reis R, Andrade C. Sentinel lymph node mapping vs systematic lymphadenectomy for endometrial cancer: surgical morbidity and lymphatic complications. J Minim Invasive Gynecol. 2020;27(4):938–e9452. PubMed

Oonk MHM, Planchamp F, Baldwin P, Mahner S, Mirza MR, Fischerová D, et al. European society of gynaecological oncology guidelines for the management of patients with vulvar Cancer - Update 2023. Int J Gynecol Cancer. 2023;33(7):1023–43. PubMed PMC

Collins A, Phillips A. Sentinel lymph node mapping in the modern management of gynaecological malignancy. Obstet Gynaecol. 2023;25(3):210–9.

Chacon E, El Hajj H, Hsu HC, Bizzarri N, Tsibulak I, Collins A et al. Global practice patterns of Sentinel lymph node biopsy in endometrial cancer: a survey from the European network of young gynecologic oncologists (ENYGO). Int J Gynecol Cancer. 2024;100068. PubMed

Rossi EC, Kowalski LD, Scalici J, Cantrell L, Schuler K, Hanna RK, et al. A comparison of Sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): a multicentre, prospective, cohort study. Lancet Oncol. 2017;18(3):384–92. PubMed

Persson J, Salehi S, Bollino M, Lönnerfors C, Falconer H, Geppert B. Pelvic Sentinel lymph node detection in High-Risk endometrial cancer (SHREC-trial)-the final step towards a paradigm shift in surgical staging. Eur J Cancer Oxf Engl 1990. 2019;116:77–85. PubMed

Marchocki Z, Cusimano MC, Vicus D, Pulman K, Rouzbahman M, Mirkovic J, et al. Diagnostic accuracy of frozen section and patterns of nodal spread in high grade endometrial cancer: A secondary outcome of the SENTOR prospective cohort study. Gynecol Oncol. 2023;173:41–8. PubMed

Ducie JA, Eriksson AGZ, Ali N, McGree ME, Weaver AL, Bogani G, et al. Comparison of a Sentinel lymph node mapping algorithm and comprehensive lymphadenectomy in the detection of stage IIIC endometrial carcinoma at higher risk for nodal disease. Gynecol Oncol. 2017;147(3):541–8. PubMed

Marchocki Z, Cusimano MC, Clarfield L, Kim SR, Fazelzad R, Espin-Garcia O et al. Sentinel lymph node biopsy in high-grade endometrial cancer: a systematic review and meta-analysis of performance characteristics. Am J Obstet Gynecol. 2021;225(4):367.e1-367.e39. PubMed

Bogani G, Giannini A, Vizza E, Di Donato V, Raspagliesi F. Sentinel node mapping in endometrial cancer. J Gynecol Oncol. 2024;35(1):e29. PubMed PMC

Schlappe BA, Weaver AL, Ducie JA, Eriksson AGZ, Dowdy SC, Cliby WA, et al. Multicenter study comparing oncologic outcomes between two nodal assessment methods in patients with deeply invasive endometrioid endometrial carcinoma: A Sentinel lymph node algorithm versus a comprehensive pelvic and paraaortic lymphadenectomy. Gynecol Oncol. 2018;151(2):235–42. PubMed PMC

Jaafar E, Gaultier V, Wohrer H, Estevez JP, Gonthier C, Koskas M. Impact of Sentinel lymph node mapping on survival in patients with high-risk endometrial cancer in the early stage: A matched cohort study. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2024;165(2):677–84. PubMed

Lecointre L, Lodi M, Faller É, Boisramé T, Agnus V, Baldauf JJ, et al. Diagnostic accuracy and clinical impact of Sentinel lymph node sampling in endometrial cancer at high risk of recurrence: A Meta-Analysis. J Clin Med. 2020;9(12):3874. PubMed PMC

Cibula D, Abu-Rustum NR. Pelvic lymphadenectomy in cervical cancer–surgical anatomy and proposal for a new classification system. Gynecol Oncol. 2010;116(1):33–7. PubMed

Aj L. Female Pelvic Vein Embolization: Indications, Techniques, and Outcomes. Cardiovasc Intervent Radiol [Internet]. 2015 Aug [cited 2024 Oct 4];38(4). Available from: https://pubmed.ncbi.nlm.nih.gov/25804635/ PubMed PMC

Taşkın S, Altin D, Vatansever D, Tokgozoglu N, Karabük E, Turan H, et al. Sentinel lymph node biopsy in early stage endometrial cancer: a Turkish gynecologic oncology group study (TRSGO-SLN-001). Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2020;30(3):299–304. PubMed

Insalaco G, Incognito GG, Genovese F, Gulino FA, Rivoli L, Ciancio F, et al. Impact of obesity in the identification of the Sentinel lymph node in endometrial cancer: a retrospective, monocentric study and literature review. Arch Gynecol Obstet. 2024;309(6):2779–88. PubMed PMC

Mauro J, Raimondo D, Di Martino G, Gasparri ML, Restaino S, Neola D, et al. Assessment of Sentinel lymph node mapping with different volumes of indocyanine green in early-stage endometrial cancer: the ALIEN study. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2024;34(6):824–9. PubMed

Sozzi G, Fanfani F, Berretta R, Capozzi VA, Uccella S, Buono N, et al. Laparoscopic Sentinel node mapping with intracervical indocyanine green injection for endometrial cancer: the SENTIFAIL study - a multicentric analysis of predictors of failed mapping. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2020;30(11):1713–8. PubMed

Garrett AA, Wield A, Mumford B, Janmey I, Wang L, Grosse P, et al. Clinical factors associated with failed Sentinel lymph node mapping in endometrial cancer. Gynecol Oncol Rep. 2022;44:101080. PubMed PMC

Emons G, Kim JW, Weide K, de Gregorio N, Wimberger P, Trillsch F, et al. Endometrial cancer lymphadenectomy trial (ECLAT) (pelvic and para-aortic lymphadenectomy in patients with stage I or II endometrial cancer with high risk of recurrence; AGO-OP.6). Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2021;31(7):1075–9. PubMed

Park JY, Kim JH, Baek MH, Park E, Kim SW. Randomized comparison between Sentinel lymph node mapping using indocyanine green plus a fluorescent camera versus lymph node dissection in clinical stage I-II endometrial cancer: a Korean gynecologic oncology group trial (KGOG2029/SELYE). J Gynecol Oncol. 2022;33(6):e73. PubMed PMC

Baiocchi G, Andrade CEMC, Ribeiro R, Moretti-Marques R, Tsunoda AT, Alvarenga-Bezerra V, et al. Sentinel lymph node mapping versus Sentinel lymph node mapping with systematic lymphadenectomy in endometrial cancer: an open-label, non-inferiority, randomized trial (ALICE trial). Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2022;32(5):676–9. PubMed