{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:53:28Z","timestamp":1792086808784,"version":"4.4.0"},"reference-count":34,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Lymph node (LN) assessment for cases of endometrial intraepithelial neoplasia (EIN), a known precursor to endometrial cancer (EC), is a topic of debate. Some experts believe this practice could avoid re-staging of disease and influence the decision to administer adjuvant treatment. However, it is known that obtaining sentinel lymph node (SLN) biopsies in patients with an elevated body mass index (BMI) can be more challenging. We thus sought to evaluate the effect of BMI on the SLN detection rate (DR) during robotic hysterectomy in EIN cases. Methods: We conducted a retrospective chart review for patients with a pre-operative diagnosis of EIN who underwent robotic hysterectomy with SLN sampling. Five BMI categories were determined according to the literature. Distribution normality was assessed with the Kolmogorov\u2013Smirnov test. Continuous variables, non-parametric continuous variables and categorical variables were assessed with the appropriate statistical tests (two-tailed Student\u2019s t-tests, Mann\u2013Whitney U-tests, and chi-squared tests, respectively). Results: 115 patients were included (average BMI of 34.75 \u00b1 9.38 SD). The bilateral SLN DR was not significantly different between BMI groups (p = 0.606). The difference in unilateral SLN DR between BMI groups was also non-significant (p = 0.269). When examining high BMI subgroups (BMI &gt; 30 and BMI &gt; 40), no significant difference was found in bilateral nor unilateral SLN DR. A logistic regression model showed that for every unit of BMI, the likelihood of SLN DR did not change significantly. Conclusions: We found no connection between obesity (BMI &gt; 30) or morbid obesity (BMI &gt; 40) and reduced SLN DR in EIN cases, nor a significant variation in the DR when comparing all the different BMI subgroups.<\/jats:p>","DOI":"10.3390\/cancers17182972","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T10:50:04Z","timestamp":1757587804000},"page":"2972","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Impact of Obesity on Sentinel Lymph Node Mapping in Patients with Endometrial Intraepithelial Neoplasia Undergoing Robotic Surgery: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4605-5552","authenticated-orcid":false,"given":"Tomer","family":"Bar-Noy","sequence":"first","affiliation":[{"name":"Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yossi","family":"Tzur","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6452-9868","authenticated-orcid":false,"given":"Yoav","family":"Brezinov","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6990-9592","authenticated-orcid":false,"given":"Emad","family":"Matanes","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Lozano-Franco","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, McGill University, Montreal, QC H4A 3J1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8061-375X","authenticated-orcid":false,"given":"Shannon","family":"Salvador","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7595-0313","authenticated-orcid":false,"given":"Melica Nourmoussavi","family":"Brodeur","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6227-6369","authenticated-orcid":false,"given":"Walter","family":"Gotlieb","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susie","family":"Lau","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1002\/1097-0142(19850715)56:2<403::AID-CNCR2820560233>3.0.CO;2-X","article-title":"The behavior of endometrial hyperplasia. A long-term study of \u201cuntreated\u201d hyperplasia in 170 patients","volume":"56","author":"Kurman","year":"1985","journal-title":"Cancer"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1002\/cncr.21649","article-title":"Reproducibility of the diagnosis of atypical endometrial hyperplasia: A Gynecologic Oncology Group study","volume":"106","author":"Zaino","year":"2006","journal-title":"Cancer"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1097\/AOG.0000000000001071","article-title":"Committee Opinion No. 631: Endometrial Intraepithelial Neoplasia","volume":"126","author":"Parkash","year":"2015","journal-title":"Obstet. Gynecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"60.e1","DOI":"10.1016\/j.ajog.2019.08.002","article-title":"Preoperative predictors of endometrial cancer at time of hysterectomy for endometrial intraepithelial neoplasia or complex atypical hyperplasia","volume":"222","author":"Vetter","year":"2020","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1002\/cncr.21650","article-title":"Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: A Gynecologic Oncology Group study","volume":"106","author":"Trimble","year":"2006","journal-title":"Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.ygyno.2017.12.026","article-title":"The utility of sentinel lymph node mapping in the management of endometrial atypical hyperplasia","volume":"148","author":"Touhami","year":"2018","journal-title":"Gynecol. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.ygyno.2014.10.008","article-title":"Clinically significant endometrial cancer risk following a diagnosis of complex atypical hyperplasia","volume":"135","author":"Costales","year":"2014","journal-title":"Gynecol. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"349.e1","DOI":"10.1016\/j.ajog.2010.05.004","article-title":"Complex atypical hyperplasia of the uterus: Characteristics and prediction of underlying carcinoma risk","volume":"203","author":"Leitao","year":"2010","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1093\/jnci\/djn397","article-title":"Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: Randomized clinical trial","volume":"100","author":"Basile","year":"2008","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1016\/S1470-2045(17)30068-2","article-title":"A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): A multicentre, prospective, cohort study","volume":"18","author":"Rossi","year":"2017","journal-title":"Lancet Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.ygyno.2020.04.687","article-title":"The added value of sentinel node mapping in endometrial cancer","volume":"158","author":"Kogan","year":"2020","journal-title":"Gynecol. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1136\/ijgc-2020-001724","article-title":"Laparoscopic sentinel node mapping with intracervical indocyanine green injection for endometrial cancer: The SENTIFAIL study\u2014A multicentric analysis of predictors of failed mapping","volume":"30","author":"Sozzi","year":"2020","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.ygyno.2019.08.008","article-title":"Sentinel lymph node biopsy with cervical injection of indocyanine green in apparent early-stage endometrial cancer: Predictors of unsuccessful mapping","volume":"155","author":"Tortorella","year":"2019","journal-title":"Gynecol. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1016\/j.ygyno.2015.06.024","article-title":"Factors associated with successful bilateral sentinel lymph node mapping in endometrial cancer","volume":"138","author":"Tanner","year":"2015","journal-title":"Gynecol. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2522","DOI":"10.1245\/s10434-016-5134-2","article-title":"Impact of Obesity on Sentinel Lymph Node Mapping in Patients with Newly Diagnosed Uterine Cancer Undergoing Robotic Surgery","volume":"23","author":"Eriksson","year":"2016","journal-title":"Ann. Surg. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.ygyno.2022.10.023","article-title":"Is sentinel lymph node assessment useful in patients with a preoperative diagnosis of endometrial intraepithelial neoplasia?","volume":"168","author":"Matanes","year":"2023","journal-title":"Gynecol. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1016\/j.jogc.2021.04.014","article-title":"Sentinel Lymph Node Sampling as an Alternative to Lymphadenectomy in Patients With Endometrial Cancer and Obesity","volume":"43","author":"Matanes","year":"2021","journal-title":"J. Obs. Gynaecol. Can."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1136\/ijgc-2022-003431","article-title":"Surgical and oncological outcomes of sentinel lymph node sampling in elderly patients with intermediate to high-risk endometrial carcinoma","volume":"32","author":"Matanes","year":"2022","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Chiu, W.K., Kwok, S.T., Wang, Y., Luk, H.M., Chan, A.H.Y., and Tse, K.Y. (2022). Applications and Safety of Sentinel Lymph Node Biopsy in Endometrial Cancer. J. Clin. Med., 11.","DOI":"10.3390\/jcm11216462"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/j.ygyno.2021.07.004","article-title":"Lymph node assessment at the time of hysterectomy has limited clinical utility for patients with pre-cancerous endometrial lesions","volume":"162","author":"Sullivan","year":"2021","journal-title":"Gynecol. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.ygyno.2018.06.001","article-title":"Tips and tricks to improve sentinel lymph node mapping with Indocyanin green in endometrial cancer","volume":"150","author":"Body","year":"2018","journal-title":"Gynecol. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.ajog.2016.11.1033","article-title":"Sentinel lymph node assessment in endometrial cancer: A systematic review and meta-analysis","volume":"216","author":"Fader","year":"2017","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.ygyno.2022.03.003","article-title":"Impact of Obesity on Sentinel Lymph Node Mapping in Patients with apparent Early-Stage Endometrial Cancer: The ObeLyX study","volume":"165","author":"Vargiu","year":"2022","journal-title":"Gynecol. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e2400","DOI":"10.1002\/rcs.2400","article-title":"\u201cIavazzo score\u201d, a preoperative score to predict duration of robotic-assisted gynaecological surgeries","volume":"18","author":"Iavazzo","year":"2022","journal-title":"Int. J. Med. Robot."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.1007\/s11701-023-01609-8","article-title":"Morbid obesity increases the failure rate of sentinel lymph node mapping for endometrial carcinoma","volume":"17","author":"Johnson","year":"2023","journal-title":"J. Robot. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1097\/AOG.0000000000004352","article-title":"Uptake and Outcomes of Sentinel Lymph Node Mapping in Women With Atypical Endometrial Hyperplasia","volume":"137","author":"Dioun","year":"2021","journal-title":"Obs. Gynecol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1056\/NEJMoa021423","article-title":"Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults","volume":"348","author":"Calle","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1038\/nature01322","article-title":"Inflammation and cancer","volume":"420","author":"Coussens","year":"2002","journal-title":"Nature"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1038\/nrc2536","article-title":"Insulin and insulin-like growth factor signalling in neoplasia","volume":"8","author":"Pollak","year":"2008","journal-title":"Nat. Rev. Cancer"},{"key":"ref_30","first-page":"1531","article-title":"Obesity, endogenous hormones, and endometrial cancer risk: A synthetic review","volume":"11","author":"Kaaks","year":"2002","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1002\/ijc.30560","article-title":"Endometrial cancer risk prediction including serum-based biomarkers: Results from the EPIC cohort","volume":"140","author":"Fortner","year":"2016","journal-title":"Int. J. Cancer"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1016\/j.ajog.2011.05.042","article-title":"Understanding obesity and endometrial cancer risk: Opportunities for prevention","volume":"205","author":"Schmandt","year":"2011","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1677\/ERC-07-0064","article-title":"Endogenous sex hormones and endometrial cancer risk in women in the European Prospective Investigation into Cancer and Nutrition (EPIC)","volume":"15","author":"Allen","year":"2008","journal-title":"Endocr. Relat. Cancer"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.ygyno.2023.05.061","article-title":"Association of body mass index with early age at diagnosis of endometrial intraepithelial neoplasia","volume":"175","author":"Nicholson","year":"2023","journal-title":"Gynecol. Oncol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/18\/2972\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:43:49Z","timestamp":1760035429000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/18\/2972"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,11]]},"references-count":34,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["cancers17182972"],"URL":"https:\/\/doi.org\/10.3390\/cancers17182972","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,11]]}}}