Table 2. Characteristics of included studies.
| Author | Time period | Study size | Study method | Tracer used | Injection site | Cancer histology | Pathology assessment | SLN algorithm | Route of surgery | Reference standard |
|---|---|---|---|---|---|---|---|---|---|---|
| Baiocchi 2016 | June 2007 to February 2017 | 75 | Retrospective | Blue dye | Cervical injection | High-grade tumor (endometrioid grade 3 and nonendometrioid histologies: serous, clear cell, or carcinosarcoma), deep myometrial invasion (MI) (C 50%), or the presence of angiolymphatic invasion (LVSI). | H&E, IHC, ultrastaging | No | Laparotomy, conventional laparoscopies and robotic assisted laparoscopies | A systematic pelvic ± para-aortic lymphadenectomy |
| Ehrisman 2017 | 2012 to 2015 | 36 | Retrospective | Methylene blue or indocyanine green (ICG) dye | Cervical injection | Carcinosarcoma, papillary serous, clear cell, or grade 3 endometrioid adenocarcinoma | H&E, cytokeratin stain | Yes | Laparoscopic and Robotically assisted |
Complete pelvic lymphadenectomy |
| Naoura 2015 | January 2001 to December 2012 | 34 | Retrospective | Technetium and patent blue | Cervical injection | 1 EC, grade 3 endometrioid cancer with myometrial infiltration superior to 50% and type 2 EC (serous EC, carcinosarcoma and clear cell cancer) | H&E, IHC | No | NR | Systematic bilateral pelvic lymphadenectomy +/− para-aortic lymphadenectomy |
| Paley 2016 | March 2012 to May 2015 | 85 | Prospective | ICG | Cervical injection | Serous, clear cell or carcinosarcoma histology on preoperative biopsy, tumor size >2 cm, >50% myometrial wall invasion, grade 3 histology |
H&E,intraoperative frozen | No | Robotic-assisted | Bilateral pelvic and periaortic LND |
| Papadia 2018 | December 2012 to July 2017 | 42 | Retrospective | ICG | Cervical injection | Grade 3 endometrial cancer or a high-risk histology (papillary serous, clear cell carcinoma, carcinosarcoma, and neuroendocrine carcinoma) | H&E, ultrastaging | Yes | Laparoscopic | Full pelvic and para-aortic lymphadenectomy up to the renal vessels |
| Rajanbabu 2018 | March 2015 to September 2017 | 25 | Prospective | ICG | Cervical injection | PORTEC II risk stratification with high-risk | H&E | Yes | Robotic-assisted laparoscopic surgery | Bilateral pelvic and paraaortic LND where SLN’s were not detected |
| Ruiz 2018 | June 26, 2014 to October 31, 2016 | 69 | Retrospective | ICG | Cervical and fundal injection | Stage IA G3 with endometrioid type Stage IB (G1 and G2) with endometrioid type Stage IB G3 with endometrioid type all stages with non-endometrioid type |
H&E, ultrastaging | No | Laparoscopic surgery | Pelvic and para-aortic lymphadenectomy |
| Soliman 2017 | April 2013 to May 2016 | 101 | Prospective | Indocyanine green; blue dye (Lymphazurin) Tc-99 | Cervical injection | Serous, clear cell, FIGO grade 3 endometrioid, or carcinosarcoma histology based on preoperative sampling. Patients with biopsy-proven cervical involvement or FIGO grade 1/2 endometrioid tumors with suspected deep myometrial invasion on imaging were also eligible. | H&E, pan-cytokeratin stain | No | Robotic, laparoscopy and laparotomy | Full pelvic and para-aortic lymphadenectomy up to the renal vessels |
| Togami 2018 | April 1, 2014, to December 27, 2017 | 40 | Prospective | ICG | Cervical and uterine fundus | Myometrial invasion >50% and/or endometrioid carcinoma grade 3, serous carcinoma, or clear cell carcinoma | H&E | Yes | Laparotomy, laparoscopy or robotic hysterectomy | Pelvic lymphadenectomy with or without para-aortic lymphadenectomy, |
| Touhami 2017 | November 2010 to November 2016 | 128 | Retrospective | Blue dye and Tcm-99 and ICG | Cervical injection | Grade 3 endometrioid, serous, carcinosarcoma, clear cell and undifferentiated | H&E, ultrastaging | No | Laparoscopy or laparoscopically-assisted vaginal surgery, robotic surgery or laparotomy. | Complete pelvic lymphadenectomy ± para-aortic lymphadenectomy |
| Wang 2019 | August 2016 to August 2018 | 98 | Retrospective | ICG | Cervical injection | Serous, clear cell, FIGO grade 3 endometrioid, or carcinosarcoma,Patients with biopsyproven cervical involvement or FIGO grade 1/2 endometrioid tumors with deep myometrial invasion | H&E, IHC | Yes | NR | Pelvic with or without paraaortic lymphadenectomy |
| Ye 2019 | Between July 2016 to July 2018 | 25 | Prospective | ICG | Cervical injection | Grade 3 endometrioid, carcinosarcoma, serous, clear cell, or undifferentiated carcinoma | H&E, ultrastaging | No | Laparoscopic surgery | Complete bilateral lymphadenectomy ± paraaortic lymphadenectomy to the inferior mesenteric artery |
EC, endometrial cancer; H&E, hematoxylin and eosin; ICG, indocyanine green; IHC, immunohistochemistry; LND, lymphadenectomy; NR, not reported; SLN, sentinel lymph node; Tc-99m, technecium-99.