ArticleCurrent oncology (Toronto, Ont.)2026
Sentinel Lymph Node Mapping Without Intraoperative Frozen Section in Preoperative Endometrial Intraepithelial Neoplasia/Atypical Endometrial Hyperplasia: Feasibility, Diagnostic Yield, and the Estimated Consequence of Frozen-Section Triage.
Article in Current oncology (Toronto, Ont.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEndometrial intraepithelial neoplasia/atypical endometrial hyperplasia (EIN/AEH) carries a substantial risk of concurrent endometrial carcinoma at hysterectomy. Sentinel lymph node (SLN) mapping requires cervical injection into an intact uterus, so the decision to map must be made before uterine pathology is known. A strategy that defers that decision to intraoperative frozen section therefore does not choose between mapping and no mapping; it forecloses mapping altogether. We evaluated the technical feasibility and diagnostic yield of SLN mapping performed without frozen section in patients with preoperative EIN/AEH and estimated how much of the nodal disease identified might not have been detected under a frozen-section-guided pathway.
methodsIn this retrospective single-center study, 86 patients with a preoperative diagnosis of EIN/AEH underwent hysterectomy, bilateral salpingo-oophorectomy, and SLN mapping with methylene blue between November 2021 and May 2026. No patient underwent intraoperative frozen section, and all SLNs underwent ultrastaging. Patients were grouped by final histopathology, and carcinomas were staged according to FIGO 2023. A counterfactual analysis applied the Mayo intraoperative triage criteria to the final uterine pathology and considered two mechanisms separately: patients who would not have undergone nodal assessment at all, and patients who would have undergone lymphadenectomy but whose disease volume might not have been detected by conventional nodal pathology.
resultsFinal pathology showed persistent EIN/AEH in 37 patients (43.0%) and endometrial carcinoma in 49 (57.0%). Patients upgraded to carcinoma were older (60.3 ± 9.5 vs. 53.1 ± 10.4 years,
conclusionsSLN mapping performed before hysterectomy and without intraoperative frozen section was technically feasible with methylene blue alone and identified occult nodal disease, a substantial part of which might not have been detected under a frozen-section-guided pathway. These findings establish feasibility and diagnostic yield only: the study has no comparison group and supports no conclusion about survival, morbidity, or cost-effectiveness. Because 43.0% of patients had EIN/AEH-only pathology, mapping should form part of individualized preoperative counseling rather than be applied universally.
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