OBJECTIVES: This study aimed to evaluate the introduction of sentinel lymph node biopsy (SLNB) in early-stage endometrial cancer (EC), its learning curve, and factors influencing discrepancies between surgeons and pathologists. METHODS: A single-centre retrospective observational study was conducted from June 2019 to December 2024 at the Department of Obstetrics and Gynecology, University Hospital Brno and Faculty of Medicine, Masaryk University. Patients with EC with complete preoperative staging and planned for extrafascial hysterectomy with bilateral salpingo-oophorectomy and SLNB were included. Bilateral detection rates were compared among two main surgeons-one senior fellow (A) and one junior fellow (B)-and other supervised fellows. Learning curves were assessed using detection rates and cumulative sum analysis. Risk factors for failed detection were analysed. RESULTS: In 337 patients, overall bilateral detection rates ranged from 80-92%. Surgeon A achieved 80% success by the 30th procedure and 89% at the 74th. Surgeon B, trained under A's supervision, reached 89% but later showed a decline after operating independently. The highest concordance with pathologists was noted for Surgeon A (94.6%), followed by B (92.2%) and others (84.9%). Discrepancies were mainly associated with the presence of fibroids (p = 0.005) and adenomyosis (p = 0.018). CONCLUSIONS: SNB in EC demonstrates an optimal learning curve that can be shortened through expert guidance. Extending supervised training to 30-35 procedures reduces post-independence decline and sustains high detection rates. Bilateral success, reflecting surgeon-pathologist concordance, is a strong indicator of the quality of a Gynecologic Oncology centre.

Department of Obstetrics and Gynecology University Hospital Brno and Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

Department of Pathology University Hospital Brno and Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

Institute of Biostatistics and Analysis Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

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Concin N., Matias-Guiu X., Cibula D., Colombo N., Creutzberg C.L., Ledermann J., Mirza M.R., Vergote I., Abu-Rustum N.R., Bosse T., et al. ESGO-ESTRO-ESP guidelines for the management of patients with endometrial carcinoma: Update 2025. Lancet Oncol. 2025;26:e423–e435. doi: 10.1016/S1470-2045(25)00167-6. PubMed DOI

Zhai L., Zhang X., Cui M., Wang J. Sentinel Lymph Node Mapping in Endometrial Cancer: A Comprehensive Review. Front. Oncol. 2021;11:701758. doi: 10.3389/fonc.2021.701758. PubMed DOI PMC

Backes F.J., Cohen D., Salani R., Cohn D.E., O’Malley D.M., Fanning E., Suarez A.A., Fowler J.M. Prospective clinical trial of robotic sentinel lymph node assessment with isosulfane blue (ISB) and indocyanine green (ICG) in endometrial cancer and the impact of ultrastaging (NCT01818739) Gynecol. Oncol. 2019;153:496–499. doi: 10.1016/j.ygyno.2019.03.252. PubMed DOI

Ruscito I., Gasparri M.L., Braicu E.I., Bellati F., Raio L., Sehouli J., Mueller M.D., Panici P.B., Papadia A. Sentinel Node Mapping in Cervical and Endometrial Cancer: Indocyanine Green Versus Other Conventional Dyes—A Meta-Analysis. Ann. Surg. Oncol. 2016;23:3749–3756. doi: 10.1245/s10434-016-5236-x. PubMed DOI

Rossi E.C., Jackson A., Ivanova A., Boggess J.F. 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;23:1704–1711. doi: 10.1097/IGC.0b013e3182a616f6. PubMed DOI

Gedgaudaite M., Paskauskas S., Bartusevicius A., Celiesiute J., Svedas E., Vaitkiene D., Drejeriene E., Inciura A., Gaurilcikas A. Laparoscopic sentinel lymph node mapping with indocyanine green in endometrial cancer: Surgeon’s learning curve (cumulative sum analysis) Int. J. Gynecol. Cancer Off. J. Int. Gynecol. Cancer Soc. 2023;33:521–527. doi: 10.1136/ijgc-2022-004033. PubMed DOI PMC

Argote L., Epple D. Learning curves in manufacturing. Science. 1990;247:920–924. doi: 10.1126/science.247.4945.920. PubMed DOI

Williams S.M., Parry B.R., Schlup M.M. Quality control: An application of the cusum. BMJ. 1992;304:1359–1361. doi: 10.1136/bmj.304.6838.1359. PubMed DOI PMC

Concin N., Matias-Guiu X., Vergote I., Cibula D., Mirza M.R., Marnitz S., Ledermann J., Bosse T., Chargari C., Fagotti A., et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int. J. Gynecol. Cancer Off. J. Int. Gynecol. Cancer Soc. 2021;31:12–39. doi: 10.1136/ijgc-2020-002230. PubMed DOI

Baeten I.G.T., Hoogendam J.P., Braat A.J.A.T., de Keizer B., Gerestein C.G., Zweemer R.P. Learning curve and factors influencing successful robot-assisted bilateral sentinel lymph node mapping in early-stage cervical cancer: An observational cohort study. Expert Rev. Med. Devices. 2023;20:589–596. doi: 10.1080/17434440.2023.2212157. PubMed DOI

Kim S., Ryu K.J., Min K.J., Lee S., Jung U.S., Hong J.H., Song J.Y., Lee J.K., Lee N.W. Learning curve for sentinel lymph node mapping in gynecologic malignancies. J. Surg. Oncol. 2020;121:599–604. doi: 10.1002/jso.25853. PubMed DOI

Tucker K., Staley S.-A., Gehrig P.A., Soper J.T., Boggess J.F., Ivanova A., Rossi E. Defining the learning curve for successful staging with sentinel lymph node biopsy for endometrial cancer among surgeons at an academic institution. Int. J. Gynecol. Cancer Off. J. Int. Gynecol. Cancer Soc. 2020;30:346–351. doi: 10.1136/ijgc-2019-000942. PubMed DOI

Body N., Grégoire J., Renaud M.-C., Sebastianelli A., Grondin K., Plante M. Tips and tricks to improve sentinel lymph node mapping with Indocyanin green in endometrial cancer. Gynecol. Oncol. 2018;150:267–273. doi: 10.1016/j.ygyno.2018.06.001. PubMed DOI

Plante M., Touhami O., Trinh X.-B., Renaud M.-C., Sebastianelli A., Grondin K., Gregoire J. Sentinel node mapping with indocyanine green and endoscopic near-infrared fluorescence imaging in endometrial cancer. A pilot study and review of the literature. Gynecol. Oncol. 2015;137:443–447. doi: 10.1016/j.ygyno.2015.03.004. PubMed DOI

Brezgyte G., Mills M., van Zanten M., Gordon K., Mortimer P.S., Ostergaard P. A systematic review of indocyanine green lymphography imaging for the diagnosis of primary lymphoedema. Br. J. Radiol. 2025;98:517–526. doi: 10.1093/bjr/tqaf006. PubMed DOI PMC

Raffone A., Fanfani F., Raimondo D., Rovero G., Renzulli F., Travaglino A., De Laurentiis U., Santoro A., Zannoni G.F., Casadio P., et al. Predictive factors of sentinel lymph node failed mapping in endometrial carcinoma patients: A systematic review and meta-analysis. Int. J. Gynecol. Cancer Off. J. Int. Gynecol. Cancer Soc. 2023;33:853–859. doi: 10.1136/ijgc-2022-004014. PubMed DOI

Andreika L., Šiaudinytė M., Vankevičienė K., Ramašauskaitė D., Rudaitis V. Analysis of Predictive Factors Associated with Unsuccessful Sentinel Lymph Node Mapping in Endometrial Carcinoma. Cancers. 2024;16:3680. doi: 10.3390/cancers16213680. PubMed DOI PMC