To determine whether sentinel lymph node mapping (SLN) in patients with endometrial hyperplasia is a practice that should be preserved or abandoned, researchers assessed outcomes for all patients in a prospective databases (2017-2021) who had been “diagnosed with premalignant pathology on preoperative endometrial biopsy (including endometrial intraepithelial neoplasia, complex atypical hyperplasia, and hyperplasia bordering on carcinoma) who underwent hysterectomy alone (27%) or with SLN mapping (73%). Among the latter group, 98% underwent bilateral SLN mapping. Among all participants, final hysterectomy pathology found that 45% had FIGO grade 1-2 endometriod endometrial cancer, including 28% in the hysterectomy alone group and 50% in the hysterectomy plus SLN mapping group. All of the 10% of overall patients who received adjuvant treatment were in the latter group. “SLN mapping did not increase postoperative morbidity and showed a low incidence of occult disease but can help avoid reoperation with full lymphadenectomy for staging,” stated the study team. “Referral of [patients] with endometrial hyperplasia to gynecologic oncologists provides an opportunity for shared decision making to balance the risks and benefits of SLN biopsy.”
