Laparoscopy guided Indocyanine Green-Guided Pelvic and Para-Aortic Sentinel Lymph Node Mapping in High-Risk Endometrial Cancer: A Step Toward Precision Staging

Background: Endometrial cancer is the sixth most common malignancy in women worldwide. While systematic lymphadenectomy provides prognostic information in high-risk cases, it increases perioperative morbidity without a consistent survival benefit. Although sentinel lymph node biopsy (SLNB) has been validated for low-risk disease, its role in intermediate to high-risk endometrial cancer remains uncertain. Objective: To evaluate the diagnostic accuracy of laparoscopic indocyanine green (ICG)-guided SLNB in intermediate-to high-risk endometrial cancer as an alternative to complete lymphadenectomy. Methods: This prospective, non-randomized, single-institute study included 47 women with presumed FIGO stage I–II high-risk endometrial cancer (July 2022–July 2024). National board of examinations India, reviewed the study and approved ethical and scientific clearance – number 2144105624 (30/6/2022) All patients underwent hysterectomy with bilateral salphingo-oophorectomy, laparoscopic ICG-guided pelvic and para aortic SLNB, and complete pelvic and para-aortic lymphadenectomy. ICG was injected into the cervix, and the diagnostic parameters were compared using full lymphadenectomy as the reference. Results: Bilateral mapping was achieved in all cases with reinjection. Pelvic lymph node metastases were found in 6 patients (12.8%), with 5 identified by SLNB (sensitivity 83.3%, negative predictive value 100%). Para-aortic metastases occurred in 5 patients (10.6%), with 4 correctly identified (sensitivity 80%, Negative predictive value 80%). Diagnostic accuracy was 97.87% for pelvic and 88.89% for para-aortic nodes. Mean harvested nodes: 21 pelvic (range 6–34), 33 para-aortic (range 15–58). Nine patients (19.1%) had postoperative complications (mostly Clavien-Dindo grade I–II); readmission rate was 4.2%. Conclusion: ICG-guided SLNB shows high negative predictive value and accuracy in intermediate to high-risk endometrial cancer. It offers a reliable, less invasive alternative to complete lymphadenectomy, potentially reducing surgical morbidity without compromising diagnostic efficacy.