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A preoperative risk-based algorithm was developed to individualize sentinel lymph node biopsy (SLNB) decisions. Methods: EIN patients planning hysterectomy were prospectively managed using endometrial stripe (EMS) and pathology results to guide SLNB with indocyanine green. Results: Among 50 patients, 48% had cancer and 16% high-risk cancers; algorithm-based decisions achieved high sensitivity and an 89% negative predictive value. Conclusions: Using EMS and pathology, the algorithm supports high-sensitivity nodal assessment and may enable surgical de-escalation and individualized treatment.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/a-prospective-algorithm-for-pre-operative-risk-stratification-and-individualized-lymph-node-assessment-in-patients-with-endometrial-intraepithelial-neoplasia-ein/353346/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/a-prospective-algorithm-for-pre-operative-risk-stratification-and-individualized-lymph-node-assessment-in-patients-with-endometrial-intraepithelial-neoplasia-ein/353346.png","ImageObject",300,407,{"name":92,"@type":93},"RuangKosong","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-22","2026-09-22",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is lymph node assessment challenging in endometrial intraepithelial neoplasia (EIN)?","Question",{"text":112,"@type":113},"EIN has a 35–40% risk of underlying carcinoma, so skipping lymph node sampling can yield incomplete staging. However, assessing all patients can lead to overtreatment in those without cancer.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How does the proposed algorithm decide whether to perform sentinel lymph node biopsy (SLNB)?",{"text":117,"@type":113},"Patients with endometrial stripe (EMS) ≥ 15 mm on pre-operative ultrasound, or pathology indicating “EIN-cannot rule out carcinoma,” undergo indocyanine green injection and SLNB. Patients with EMS \u003C 15 mm undergo hysterectomy without SLNB.",{"name":119,"@type":110,"acceptedAnswer":120},"What were the main performance outcomes of the algorithm?",{"text":121,"@type":113},"Algorithm-based decisions showed 92% sensitivity for achieving surgical staging of cancer and 100% sensitivity for staging high-risk cancers. The negative predictive value for correctly identifying patients without cancer was 89%.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},353346,1790175065,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144},962090883219,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Gynecologic Oncology Reports 66 (2026) 102177  \nContents lists available at ScienceDirect  \nGynecologic Oncology Reports  \njournal [homepage:](homepage: www.elsevier.com/locate/gynor)[ www.elsevier.com/locate/gynor](homepage: www.elsevier.com/locate/gynor)  \n| A prospective algorithm for pre-operative risk stratification and individualized lymph node assessment in patients with endometrial intraepithelial neoplasia (EIN)☆\u003Cbr>Pamela N. Petersa,b,*, Lauren March b, Georgia D. Smith b, Elizabeth A. Bloom c,\u003Cbr>Rebecca A. Previsb,d, Angeles Alvarez Secord b, Laura J. Havrileskyb, Emma C. Rossib\u003Cbr>a Sutter East Bay Medical Group, Berkeley, CA, United States of America\u003Cbr>b Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Duke University, Durham, NC, United States of America c Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America\u003Cbr>d Labcorp, Durham, NC, United States of America |  |  |\n| --- | --- | --- |\n| A R T I C L E I N F O |  | A B S T R A C T |\n| Keywords:\u003Cbr>Endometrial intraepithelial neoplasia Sentinel lymph node biopsy Endometrial cancer\u003Cbr>Surgical staging Endometrial stripe Pelvic ultrasound |  | Objectives: The standard of care surgical management of endometrial intraepithelial neoplasia (EIN) is debated. Because EIN carries a 35–40% risk of underlying carcinoma, omission of lymph node sampling can result in incomplete staging. However, lymph node assessment for all patients results in overtreatment for those without cancer. We developed a preoperative risk-based algorithm to direct sentinel lymph node biopsy (SLNB) in EIN. Methods: Patients with EIN planning hysterectomy were treated prospectively according to our algorithm. Patients with an endometrial stripe (EMS) ≥ 15 mm by pre-operative ultrasound or “EIN-cannot rule out carcinoma” on pathology underwent indocyanine green (ICG) injection and SLNB. Patients with EMS \u003C 15 mm underwent hysterectomy without SLNB.\u003Cbr>Results: From August 2022–November 2023, 50 patients with EIN underwent hysterectomy. 48%(24/50) had cancer on final pathology, and 16%(8/50) had high-risk cancers (defined as meeting high-intermediate risk criteria for adjuvant radiation, high grade histology, or stage II or higher). SLNB was performed in 92%(22/24) of patients with cancer, including 100%(8/8) with high-risk cancers. Surgical decision making based on the algorithm had 92% sensitivity for achieving surgical staging of cancer and 100% sensitivity for staging high-risk cancers. The negative predictive value of the algorithm (NPV) to correctly identify patients without cancer was 89%.\u003Cbr>Conclusions: A preoperative risk-based algorithm using EMS and pathology results has high sensitivity to identify and direct nodal assessment for patients with EIN at higher risk for endometrial cancer. The algorithm may allow for de-escalation and individualization of surgical treatment for EIN. |\n\n1. Introduction  \nEndometrial intraepithelial neoplasia (EIN) is a precursor to endometrial carcinoma, often conceptualized as carcinoma in situ of the endometrium. Up to 40% of patients diagnosed with EIN by endometrial sampling (endometrial biopsy or D&C) ultimately have invasive carcinoma on final hysterectomy specimen (Leitao Jr. et al., 2010). Most patients with pre-operative EIN who are upstaged to endometrial cancer at definitive surgery exhibit low-risk pathologic features, resulting in a low incidence of lymph node metastases. However, 5–10% have “high-  \nrisk” features where nodal assessment provides clinically relevant information for treatment planning (Costales et al., 2014; Matanes et al., 2022; Mueller et al., 2022; Sullivan et al., 2021). Patients with “lowrisk” features are typically managed with observation without adjuvant therapy is reasonable even in the absence of complete staging, however“high-risk” features such as deep myometrial invasion, lymphovascular space invasion (LVSI), high grade histologies, or ","cbCailaEgdVMg1DG","https://ap.wps.com/l/cbCailaEgdVMg1DG","pdf",1231777,"English","# Objectives\n# Methods\n# Results\n# Conclusions\n# Introduction","[{\"question\":\"Why is lymph node assessment challenging in endometrial intraepithelial neoplasia (EIN)?\",\"answer\":\"EIN has a 35–40% risk of underlying carcinoma, so skipping lymph node sampling can yield incomplete staging. However, assessing all patients can lead to overtreatment in those without cancer.\"},{\"question\":\"How does the proposed algorithm decide whether to perform sentinel lymph node biopsy (SLNB)?\",\"answer\":\"Patients with endometrial stripe (EMS) ≥ 15 mm on pre-operative ultrasound, or pathology indicating “EIN-cannot rule out carcinoma,” undergo indocyanine green injection and SLNB. Patients with EMS \\u003c 15 mm undergo hysterectomy without SLNB.\"},{\"question\":\"What were the main performance outcomes of the algorithm?\",\"answer\":\"Algorithm-based decisions showed 92% sensitivity for achieving surgical staging of cancer and 100% sensitivity for staging high-risk cancers. The negative predictive value for correctly identifying patients without cancer was 89%.\"}]","A prospective algorithm for pre-operative risk stratification and individualized lymph node assessment in patients with endometrial intraepithelial neoplasia (EIN) | PDF",1790104826,18]