Global practice patterns of sentinel lymph node biopsy in endometrial cancer: a survey from the European Network of Young Gynecologic Oncologists (ENYGO)

Objective: This survey aimed to evaluate trends in sentinel lymph node (SLN) biopsy for endometrial cancer among members of the European Society of Gynecologic Oncology (ESGO) and the International Gynecologic Cancer Society (IGCS). Methods: We conducted an online cross-sectional survey among gynecologic oncologists over 40 years of age consisting of 30 questions. It was distributed to ESGO and IGCS members via Survey Monkey and Qualtrics between September and December 2022. Surveys were excluded in the analysis if >50% of questions were incomplete. Statistical analysis, performed with SPSS version 27.0. Results: A total of 302 (70.2%) of 430 participants completed the survey, with 159 (52.6%) affiliated with ESGO and 143 (47.4%) with IGCS. The majority were male 206 (68.2%), and 170 (56.3%) were based in Europe. Most respondents (n = 261, 86.4%) were certified gynecologic oncologists. Indocyanine green was the most common tracer used (n = 234, 77.5%), with higher rates of blue dye injections among IGCS respondents (p = .002). The predominant injection volume was 4 cm³ (51%, n = 154). Most respondents (n = 232, 76.8%) used a combined superficial and deep ectocervical injection technique, with a higher proportion of superficial injections alone in the IGCS respondents (25.9% vs 11.9%, p = .003). Nearly half of the respondents (44.4%, n = 134) started SLN mapping at the uterine artery and continued dissecting laterally. In cases of mapping failure, 77.5% (n = 234) opted for side-specific lymphadenectomy. The Memorial Sloan Kettering Cancer Center algorithm was followed by 69.5% (n = 210), with 45.7% (n = 138) routinely using ex-vivo green fluorescence or gamma counter measurements. Finally, there was a higher adoption of immunohistochemistry for SLN ultra-staging in ESGO (n = 116, 73%) compared to the IGCS respondents (n = 94, 65.7%), (p = .047). Conclusions: This study showed significant variations in SLN biopsy practices for endometrial cancer, underscoring the need for global standardization through harmonized guidelines, consistent training, and international collaboration to improve staging accuracy and patient outcomes.