{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T03:13:59Z","timestamp":1788837239208,"version":"build-2803163510"},"reference-count":50,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"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: Accurate intraoperative assessment of sentinel lymph node (SLN) status is critical for staging and guiding surgical management in gynaecological malignancies. Frozen-section histopathology remains the gold standard, but it is time-consuming and resource-intensive. Shear-wave elastography (SWE) quantifies tissue stiffness in real time and may offer a rapid alternative. Methods: In this prospective single-centre study, 63 women (median age 62 years) undergoing primary surgery with sentinel lymph node biopsy (SLNB) for endometrial, cervical, vulvar, or early ovarian carcinoma were enrolled. A total of 172 SLNs were excised, submerged in coupling gel, and scanned ex vivo using a 9 MHz linear probe. Results: A total of 172 SLNs underwent SWE (mean 2.7 nodes\/patient). Endometrial primaries accounted for 58% of nodes, mostly retrieved by robotic-assisted surgery (71.8%). Node dimensions were significantly larger in malignant lesions for sonographic (long-axis: 13.02 \u00b1 3.31 mm vs. 10.80 \u00b1 3.28 mm; p = 0.002) and pathological long-axis measurements (11.45 \u00b1 2.83 mm vs. 9.75 \u00b1 2.61 mm; p = 0.004). Mean SWE velocities were similar between groups (1.381 \u00b1 0.307 vs. 1.343 \u00b1 0.236 m\/s; p = 0.541). Histopathology identified metastases in 18% of SLNs, comprising macrometastases (7%), micrometastases (5%), and isolated tumour cells (6%). Conclusions: Although ex vivo SWE is rapid, reproducible, and integrates seamlessly into the sterile field, stiffness measurements alone lack sufficient discriminatory power for SLN staging in gynaecological cancers. Future research should focus on three-dimensional SWE, advanced radiomic analyses, and machine-learning algorithms to improve the detection of low-volume metastatic disease.<\/jats:p>","DOI":"10.3390\/cancers18020183","type":"journal-article","created":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T11:13:18Z","timestamp":1767697998000},"page":"183","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Intraoperative Ex Vivo Shear-Wave Elastography of Sentinel Lymph Nodes in Endometrial Cancer and Other Gynaecological Malignancies"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2576-2269","authenticated-orcid":false,"given":"Walid","family":"Shaalan","sequence":"first","affiliation":[{"name":"Department of Gynaecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Eldesouky","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5997-5254","authenticated-orcid":false,"given":"Theresa","family":"Mokry","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7147-2414","authenticated-orcid":false,"given":"Arved","family":"Bischoff","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Sinn","sequence":"additional","affiliation":[{"name":"Institute of Pathology, Heidelberg University, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3189-8063","authenticated-orcid":false,"given":"Nourhan","family":"Hassan","sequence":"additional","affiliation":[{"name":"Center for Molecular Medicine Cologne, University of Cologne, Robert-Koch-Street 21, 50931 Cologne, Germany"},{"name":"Biotechnology Department, Faculty of Science, Cairo University, Giza 12613, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riku","family":"Togawa","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4369-1646","authenticated-orcid":false,"given":"Dina","family":"Batarseh","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathrin","family":"Ha\u00dfdenteufel","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6381-0978","authenticated-orcid":false,"given":"Lara Meike","family":"Tretschock","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryna","family":"Hlamazda","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9241-5110","authenticated-orcid":false,"given":"Christina","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilie","family":"Torkildsen","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany"},{"name":"Department of Obstetrics and Gynaecology, Stavanger University Hospital, 4011 Stavanger, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Gerhardt","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre","family":"Hennigs","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa Katharina","family":"Nees","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Zivanovic","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Riedel","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1002\/ijgo.12749","article-title":"Revised FIGO staging for carcinoma of the cervix uteri","volume":"145","author":"Bhatla","year":"2019","journal-title":"Int. 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