5.2 SLNM in high-risk endometrial cancer
Compared with low-risk endometrial cancer, when it comes to high-risk endometrial cancer, the application value of SLNM still vary wildly. On the one hand, SLNM may increase the risk of missed diagnosis of isolated para-aortic lymph node metastases, which appears to be unacceptable in clinical practice[66]. Yet on the contrary, a meta-analysis showed that SLNM can accurately detect lymph node metastasis in high-risk endometrial cancer, and its performance characteristics (detection rate, false negative rate, sensitivity, etc. ) were not statistically different from those of low-risk endometrial cancer[67]. Conformably, Gu et al. thought that in high-risk endometrial cancer, SLNM’s evaluation effect of para-aortic lymph nodes was by no means inferior to that in low-risk endometrial cancer[68]. Meanwhile, increasing evidence have manifested the feasibility of applying SLNM in high-risk endometrial cancer[69]. The application of SLNM can shorten the time of laparotomy and laparoscopic surgery as well. Beyond this, the 2022 NCCN guidelines further proposed that SLNM can be considered as a method for surgical staging in patients with no extra-uterine metastatic lesion. This suggests that this edition of the NCCN guidelines recognizes the potential application value of SLNM in high-risk endometrial cancer patients. More large-scale, multicenter prospective studies are still needed to further settle this controversy.