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

Background

Endometrial 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.