Optimized sentinel nodes detection in endometrial cancer - intraoperative indocyanine green mapping with postoperative bread-loaf slicing ultrastaging

Q: What problem does the study address in early-stage endometrial cancer?

The study targets accurate lymph node assessment for staging, noting that traditional lymphadenectomy carries significant morbidity risk. It evaluates whether optimized SLN mapping plus ultrastaging can improve detection of metastases.

Q: How was sentinel lymph node mapping performed in this study?

SLN mapping used intraoperative ICG fluorescence imaging or patent blue dye during minimally invasive and open surgical approaches. The chosen method depended on the patient group.

Q: What ultrastaging method did the study use after surgery, and what were the key findings?

All retrieved lymph nodes underwent bread-loaf slicing ultrastaging. It identified lymph node metastases in 4.0% of patients, and no recurrence was observed among pathological stage I patients during follow-up.

Sep 23, 2026

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Accurate lymph node assessment is critical for early-stage endometrial cancer staging, yet traditional lymphadenectomy increases morbidity risk. This retrospective study evaluates whether intraoperative indocyanine green (ICG)-based sentinel lymph node (SLN) mapping combined with bread-loaf slicing ultrastaging improves metastasis detection in uterine-confined disease. Among 131 patients, SLN mapping succeeded in 93.9% and detected metastases in 95.9% overall, with bread-loaf ultrastaging identifying metastases in 4.0% and supporting a feasible standardized workflow.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Introduction

Huang et al. World Journal of Surgical Oncology (2026) 24:256 [https://doi.org/10.1186/s12957-026-04375-7](https://doi.org/10.1186/s12957-026-04375-7) World Journal of Surgical Oncology RESEARCH Open Access Optimized sentinel nodes detection in endometrial cancer: intraoperative indocyanine green mapping with postoperative bread-loaf slicing ultrastaging Yu-Sheng Huang1,2, Hao Lin2,3, Yu-Che Ou2,4, Chao-Cheng Huang5, Hung-Chun Fu2, Szu-Wei Huang2, Ying-Wen Wang2, Ying-Yi Chen2 and Chen-Hsuan Wu2* Abstract Background Accurate lymph node assessment is crucial in early-stage endometrial cancer staging, but traditionallymphadenectomy carries significant morbidity risks. This study evaluates whether indocyanine green (ICG)-based sentinel lymph node (SLN) mapping combined with bread-loaf slicing ultrastaging optimizes lymph node metastasis detection in uterine-confined endometrial cancer. Methods We retrospectively analyzed patients with early-stage endometrial cancer who underwent surgery with SLN mapping at Kaohsiung Chang Gung Memorial Hospital from November 2021 to December 2024. SLN mapping was performed using either ICG fluorescence imaging or patent blue dye during minimally invasive and open surgical approaches. All retrieved lymph nodes underwent ultrastaging examination using the bread-loaf slicing method. Results Among 131 patients, the overall SLN mapping success rate was 93. 9%, and the overall detection rate was 95. 9% . In exploratory subgroup analyses, bilateral mapping success was higher in the ICG group than in the patent blue group (79 . 2% vs. 27. 3%, p < 0. 001) . Bilateral mapping success was also higher in minimally invasive surgery than in open surgery in the overall cohort (79 . 1% vs. 43. 8%, p = 0 . 002) . Bread-loaf slicing ultrastaging identified lymph node metastases in 4. 0% of patients. No recurrence were observed among patients with pathological stage I diseases during follow-up. Conclusions The combination of intraoperative ICG-based SLN mapping with bread-loaf slicing ultrastaging demonstrated high mapping success rate and detection rate, and supports a feasible, standardized surgicalpathologic workflow for lymph node assessment in uterine-confined endometrial cancer. Keywords Endometrial Neoplasms, Indocyanine Green, Lymphatic Metastasis / pathology (Ultrastaging), Sentinel Lymph Node *Correspondence: Chen-Hsuan Wu [chenhsuan5@gmail.com](chenhsuan5@gmail.com) Full list of author information is available at the end of the article © The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/licenses/by-nc-nd/4.0/](vecommons.org/licenses/by-nc-nd/4.0/.)[.](vecommons.org/licenses/by-nc-nd/4.0/.) Huang et al. World Journal of Surgical Oncology (2026) 24:256 Introduction Endometrial cancer (EC) is a significant public health concern, ranking as the fifth most common cancer among women in Taiwan and the sixth globally [1, 2]. Its rising incidence underscores the importance of advancing diagnostic and treatment

FAQs

What problem does the study address in early-stage endometrial cancer?

The study targets accurate lymph node assessment for staging, noting that traditional lymphadenectomy carries significant morbidity risk. It evaluates whether optimized SLN mapping plus ultrastaging can improve detection of metastases.

How was sentinel lymph node mapping performed in this study?

SLN mapping used intraoperative ICG fluorescence imaging or patent blue dye during minimally invasive and open surgical approaches. The chosen method depended on the patient group.

What ultrastaging method did the study use after surgery, and what were the key findings?

All retrieved lymph nodes underwent bread-loaf slicing ultrastaging. It identified lymph node metastases in 4.0% of patients, and no recurrence was observed among pathological stage I patients during follow-up.

Sep 23, 2026

Uploaded by Elsa