Role of sentinel node mapping in endometrial cancer in 2025

Purpose of review The aim is to summarize the role of sentinel lymph node biopsy (SLN) in surgical staging for endometrial cancer (EC). Recent findings The value of SLN in EC staging continues to be demonstrated in all clinically uterine-confined disease, as SLN matches or improves the diagnostic accuracy of pelvic±para-aortic lymphadenectomy (PLD ± PALD) while reducing recovery time, surgical complications, and risk of lower extremity lymphedema. High diagnostic accuracy allows recommendation of appropriate adjuvant therapy, and recent studies have shown that even patients with high-risk histology may undergo SLN as opposed to PLD ± PALD provided this is combined with appropriate imaging. Debate about the necessity of any lymph node assessment in patients with certain low-risk features continues, with a preponderance of evidence pointing toward universal SLN in patients undergoing surgical staging for EC. In patients with negative SLN and intermediate risk uterine factors, molecular profiling is recommended to augment information gained through surgical assessment. Summary EC surgical staging with SLN is considered standard practice in clinically uterine-confined disease. This approach allows precise treatment recommendations without PLD ± PALD related side effects. The integration of molecular profiling with EC surgical staging will accelerate the benefits of therapeutic advances in EC.