{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:47:20Z","timestamp":1782452840893,"version":"3.54.5"},"reference-count":20,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Nowadays, lymph node assessment represents a key component in the surgical staging of endometrial cancer, as sentinel lymph node (SLN) mapping increased in adoption as an alternative to lymphadenectomy. This study aimed to compare SLN mapping and selective lymph node sampling (SLNS) in endometrial cancer cases managed in a tertiary oncologic center. Moreover, the study evaluated clinicopathological characteristics and the association between tumor stage and nodal involvement. Methods: This prospective observational cohort study included 137 patients with histologically confirmed endometrial cancer who underwent surgical staging between January 2020 and August 2025. Either SLN mapping using indocyanine green (ICG) or methylene blue (blue dye\u2013BD) or SLNS was performed during the surgery. Clinical, surgical, and histopathological data were analyzed using descriptive and inferential statistics. Results: SLN mapping was performed in 86 patients (BD: 45; ICG: 41), while the other 51 underwent SLNS. Median lymph node yield was significantly higher in the SLNS group (10 nodes) in comparison to SLN mapping (four nodes for both BD and ICG; p &lt; 0.001). The overall nodal metastasis rate was 9.5%, with no significant difference between techniques (SLNS: 9.8%, BD: 8.9%, ICG: 9.8%; p = 0.99). Bilateral nodal detection rates were higher in the BD group compared to the ICG group (73.3% vs. 51.2%; OR = 2.62, p = 0.045). Nodal involvement increased significantly in parallel with advancing pathological T stage (p &lt; 0.001), ranging from 0% in T1a to 40.0% in T3a disease. Conclusions: Even though SLNS resulted in a higher number of lymph nodes retrieved, SLN mapping demonstrated similar observed rates of nodal metastases across groups within the limits of this observational study. BD demonstrates superior bilateral detection rates compared to ICG in this cohort. Tumor stage remains a predictor of lymph node involvement. All these findings justify the use of SLN mapping as an effective staging strategy in patients with endometrial cancer.<\/jats:p>","DOI":"10.3390\/diagnostics16121904","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T13:04:04Z","timestamp":1781874244000},"page":"1904","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sentinel Lymph Node Mapping Compared with Selective Lymph Node Sampling in the Surgical Staging of Endometrial Cancer: A Prospective Observational Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7373-6877","authenticated-orcid":false,"given":"Vlad Alexandru","family":"G\u00e2ta","sequence":"first","affiliation":[{"name":"Department of Oncological Surgery, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"},{"name":"Department of Oncological Surgery and Gynecological Oncology, \u201cProf. Dr. Ion Chiricu\u021b\u0103\u201d Institute of Oncology, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radu Alexandru","family":"Ilie\u0219","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Maria","family":"Mure\u0219an-B\u0103descu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5910-8137","authenticated-orcid":false,"given":"\u0218tefan","family":"\u021a\u00ee\u021bu","sequence":"additional","affiliation":[{"name":"Department of Oncological Surgery and Gynecological Oncology, \u201cProf. Dr. Ion Chiricu\u021b\u0103\u201d Institute of Oncology, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9260-3994","authenticated-orcid":false,"given":"Alexandra Timea","family":"Kirsch-Mangu","sequence":"additional","affiliation":[{"name":"Department of Oncology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"},{"name":"Department of Radiation Oncology, \u201cProf. Dr. Ion Chiricu\u021b\u0103\u201d Institute of Oncology, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anda","family":"G\u00e2ta","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delia","family":"Nicoar\u0103","sequence":"additional","affiliation":[{"name":"Department of Quality Management, \u201cProf. Dr. Ion Chiricu\u021b\u0103\u201d Institute of Oncology, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"S\u00eencr\u0103ianu","sequence":"additional","affiliation":[{"name":"Department of Oncological Surgery and Gynecological Oncology, \u201cProf. Dr. Ion Chiricu\u021b\u0103\u201d Institute of Oncology, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boutaina","family":"Chakir","sequence":"additional","affiliation":[{"name":"Department of Oncological Surgery and Gynecological Oncology, \u201cProf. Dr. Ion Chiricu\u021b\u0103\u201d Institute of Oncology, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florin Lauren\u021biu","family":"Ignat","sequence":"additional","affiliation":[{"name":"Department of Oncological Surgery, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"},{"name":"Department of Oncological Surgery and Gynecological Oncology, \u201cProf. Dr. Ion Chiricu\u021b\u0103\u201d Institute of Oncology, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioan C\u0103t\u0103lin","family":"Vlad","sequence":"additional","affiliation":[{"name":"Department of Oncological Surgery, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"},{"name":"Department of Oncological Surgery and Gynecological Oncology, \u201cProf. Dr. Ion Chiricu\u021b\u0103\u201d Institute of Oncology, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru","family":"Irimie","sequence":"additional","affiliation":[{"name":"Department of Oncological Surgery and Gynecological Oncology, \u201cProf. Dr. Ion Chiricu\u021b\u0103\u201d Institute of Oncology, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9928-5883","authenticated-orcid":false,"given":"Patriciu Andrei","family":"Achima\u0219-Cadariu","sequence":"additional","affiliation":[{"name":"Department of Oncological Surgery, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"},{"name":"Department of Oncological Surgery and Gynecological Oncology, \u201cProf. Dr. Ion Chiricu\u021b\u0103\u201d Institute of Oncology, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/j.ygyno.2021.01.036","article-title":"Variations in incidence and mortality rates of endometrial cancer at the global, regional, and national levels, 1990\u20132019","volume":"161","author":"Gu","year":"2021","journal-title":"Gynecol. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1002\/jso.27550","article-title":"Sentinel lymph node mapping in endometrial cancer: Current evidence and practice","volume":"129","author":"Salman","year":"2024","journal-title":"J. Surg. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e423","DOI":"10.1016\/S1470-2045(25)00167-6","article-title":"ESGO-ESTRO-ESP guidelines for the management of patients with endometrial carcinoma: Update 2025","volume":"26","author":"Concin","year":"2025","journal-title":"Lancet Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"ASTEC Study Group, Kitchener, H., Swart, A.M., Qian, Q., Amos, C., and Parmar, M.K. (2009). Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): A randomised study. Lancet, 373, 125\u2013136. Erratum in: Lancet\u00a02009, 373, 1764.","DOI":"10.1016\/S0140-6736(08)61766-3"},{"key":"ref_5","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":"Panici","year":"2008","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_6","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_7","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1007\/s10147-023-02449-0","article-title":"Clinical outcomes of sentinel node navigation surgery in patients with preoperatively estimated stage IA endometrial cancer and evaluation of validity for continuing sentinel node navigation surgery based on dispersion of recurrence probability","volume":"29","author":"Yamashita","year":"2024","journal-title":"Int. J. Clin. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Gu, Y., Cheng, H., Zong, L., Kong, Y., and Xiang, Y. (2021). Operative and Oncological Outcomes Comparing Sentinel Node Mapping and Systematic Lymphadenectomy in Endometrial Cancer Staging: Meta-Analysis with Trial Sequential Analysis. Front. Oncol., 10.","DOI":"10.3389\/fonc.2020.580128"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1016\/S1470-2045(18)30448-0","article-title":"Near-infrared fluorescence for detection of sentinel lymph nodes in women with cervical and uterine cancers (FILM): A randomised, phase 3, multicentre, non-inferiority trial","volume":"19","author":"Frumovitz","year":"2018","journal-title":"Lancet Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.jmig.2015.10.011","article-title":"Role of Indocyanine Green in Sentinel Node Mapping in Gynecologic Cancer: Is Fluorescence Imaging the New Standard?","volume":"23","author":"Darin","year":"2016","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.ygyno.2015.04.004","article-title":"Comparing indocyanine green, technetium, and blue dye for sentinel lymph node mapping in endometrial cancer","volume":"137","author":"How","year":"2015","journal-title":"Gynecol. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Togami, S., Fufuzono, N., Fukuda, M., and Kobayashi, H. (2025). Indocyanine Green and Radioisotope Tracers for Sentinel Lymph Node Mapping in Early-Stage Cervical Cancer: A Prospective Comparative Study. Cureus, 17.","DOI":"10.7759\/cureus.82644"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"506.e1","DOI":"10.1016\/j.ajog.2020.10.042","article-title":"An ecological evaluation of the increasing incidence of endometrial cancer and the obesity epidemic","volume":"224","author":"Smrz","year":"2021","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1136\/ijgc-2022-003378","article-title":"Sentinel lymph node mapping versus sentinel lymph node mapping with systematic lymphadenectomy in endometrial cancer: An open-label, non-inferiority, randomized trial (ALICE trial)","volume":"32","author":"Baiocchi","year":"2022","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e73","DOI":"10.3802\/jgo.2022.33.e73","article-title":"Randomized comparison between sentinel lymph node mapping using indocyanine green plus a fluorescent camera versus lymph node dissection in clinical stage I\u2013II endometrial cancer: A Korean Gynecologic Oncology Group trial (KGOG2029\/SELYE)","volume":"33","author":"Park","year":"2022","journal-title":"J. Gynecol. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1136\/ijgc-2023-004474","article-title":"Sentinel lymph node sampling versus full lymphadenectomy in endometrial cancer: A SEER database analysis","volume":"33","author":"Nahshon","year":"2023","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.ygyno.2023.05.002","article-title":"Outcomes for patients with high-risk endometrial cancer undergoing sentinel lymph node assessment versus full lymphadenectomy","volume":"174","author":"Holtzman","year":"2023","journal-title":"Gynecol. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1136\/ijgc-2023-004314","article-title":"Long-term survival outcomes in high-risk endometrial cancer patients undergoing sentinel lymph node biopsy alone versus lymphadenectomy","volume":"33","author":"Capozzi","year":"2023","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Garc\u00eda-Pineda, V., Hern\u00e1ndez, A., Garrido-Mallach, S., Rodr\u00edguez-Gonz\u00e1lez, E., Alonso-Esp\u00edas, M., Gracia, M., Arnedo, R., and Zapardiel, I. (2023). Sentinel Lymph Node Impact on the Quality of Life of Patients with Endometrial Cancer. J. Pers. Med., 13.","DOI":"10.3390\/jpm13050847"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1016\/j.ygyno.2020.09.032","article-title":"Perioperative outcomes and disparities in utilization of sentinel lymph node biopsy in minimally invasive staging of endometrial cancer","volume":"159","author":"Albright","year":"2020","journal-title":"Gynecol. Oncol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/12\/1904\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:08:50Z","timestamp":1782450530000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/12\/1904"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,19]]},"references-count":20,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["diagnostics16121904"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16121904","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,19]]}}}