The aim of this study was to evaluate the difference in outcomes between individuals with premalignant endometrial pathology who have a hysterectomy with or without sentinel lymph node (SLN) removal. Surgical complications, cancer status on final pathology, postoperative therapy, and molecular risk profiles from The Cancer Genome Atlas (TCGA) were among the outcomes of interest. From 1/1/2017 to 12/31/2021, researchers identified patients who underwent hysterectomy with or without SLN mapping/excision at an institution and who were found to have premalignant disease on preoperative endometrial biopsy. 

Information was collected from clinical, pathologic, surgical, and TCGA profiles. The right kinds of statistical analyses were performed. The majority, 161 (73%) of the 221 patients, had their SLNs removed during their hysterectomy, whereas the remaining 27% had their hysterectomy performed without SLN removal. In terms of median age and BMI, there was little to no difference between the groups. However, those SLN mapping/excision had a shorter median operative time (130 minutes) than those without (136 minutes; P = 0.6). There were 9 AEs (30 days post-op; n = 15/161) and 13 AEs (30 days post-op; n = 8/60); P = 0.9. On final pathology, 98 (44% of the total) of the 221 patients were found to have endometrioid endometrial cancer, with 4 (4% of the total) being stage IB or higher. 

Adjuvant therapy was given to 10 out of 98 patients (10%), all of whom were in the SLN group. Only 33 patients (15%) received TCGA molecular classification data; of these, 27 (82%) had copy number-low disease, 3 (9%) had microsatellite instability-high disease, 2 (6%) had POLE-ultramutated disease, and 1 (3%) had copy number-high disease. Assessment of SLNs seems safe, finds a few latent nodal metastases in the upstaged, and gives extra staging information that can direct adjuvant treatment. Preoperative counseling should include information about SLN mapping and provide it in a shared decision-making format.