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FIRES SLN Endometrial — SCE Medical Oncology MCQ

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HardGynaecological CancersFIRES SLN EndometrialSCE Medical Oncology

During surgery for presumed uterus-confined high-risk endometrial carcinoma, indocyanine-green sentinel-node mapping identifies a right pelvic sentinel node but no left-sided mapping despite reinjection and exploration. There are no bulky nodes. What does the 2025 ESGO-ESTRO-ESP algorithm recommend?

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Correct answer: E — Dissect the unmapped left pelvis and ultrastage the right sentinel node

Option E is correct: failed mapping on the left in high-risk disease requires side-specific left pelvic lymphadenectomy, while the mapped right sentinel node is ultrastaged. Option A accepts incomplete staging. Option D samples the para-aortic rather than unmapped pelvic basin. Option C dissects the mapped side and samples the wrong contralateral compartment, and option B omits required sentinel-node ultrastaging.

Reference: ESGO-ESTRO-ESP 2025 endometrial cancer guideline. https://guidelines.esgo.org/media/2025/09/ESGO-ESTRO-ESP-Guidelines-for-EC_-LO-July-2025.pdf