Optimized sentinel nodes detection in endometrial cancer: intraoperative indocyanine green mapping with postoperative bread-loaf slicing ultrastaging.

BACKGROUND

Accurate lymph node assessment is crucial in early-stage endometrial cancer staging, but traditional lymphadenectomy carries significant morbidity risks. This study evaluates whether indocyanine green (ICG)-based sentinel lymph node (SLN) mapping combined with bread-loaf slicing ultrastaging optimizes lymph node metastasis detection in uterine-confined endometrial cancer.

METHODS

We retrospectively analyzed patients with early-stage endometrial cancer who underwent surgery with SLN mapping at Kaohsiung Chang Gung Memorial Hospital from November 2021 to December 2024. SLN mapping was performed using either ICG fluorescence imaging or patent blue dye during minimally invasive and open surgical approaches. All retrieved lymph nodes underwent ultrastaging examination using the bread-loaf slicing method.

RESULTS

Among 131 patients, the overall SLN mapping success rate was 93.9%, and the overall detection rate was 95.9%. In exploratory subgroup analyses, bilateral mapping success was higher in the ICG group than in the patent blue group (79.2% vs. 27.3%, p < 0.001). Bilateral mapping success was also higher in minimally invasive surgery than in open surgery in the overall cohort (79.1% vs. 43.8%, p = 0.002). Bread-loaf slicing ultrastaging identified lymph node metastases in 4.0% of patients. No recurrence were observed among patients with pathological stage I diseases during follow-up.

CONCLUSIONS

The combination of intraoperative ICG-based SLN mapping with bread-loaf slicing ultrastaging demonstrated high mapping success rate and detection rate, and supports a feasible, standardized surgical-pathologic workflow for lymph node assessment in uterine-confined endometrial cancer.