Search Results (44)

Lymphovascular space invasion (LVSI) is a well-established prognostic factor in endometrial cancer; however, its independent contribution to para-aortic nodal metastasis remains incompletely defined. Identifying factors associated with nodal dissemination is important for surgical staging and postoperative management. This retrospective, single-center cohort study included 121 patients with endometrial cancer who underwent laparoscopic pelvic and para-aortic lymphadenectomy. The cohort was predominantly obese (median BMI: 32 kg/m²). Clinicopathological variables were analyzed using univariable and multivariable logistic regression models to identify associations with lymph node metastasis and para-aortic lymph node metastasis. Lymph node metastasis was observed in 16.5% of patients, including para-aortic involvement in 9.9%. In univariable analysis, the LVSI category was significantly associated with lymph node metastasis (p = 0.002), with substantial LVSI being present in 50.0% of patients with nodal metastasis compared with 14.9% of those without. LVSI was categorized as negative, focal, or substantial. In multivariable logistic regression analyses using negative LVSI as the reference category, substantial LVSI remained independently associated with both overall nodal metastasis (OR 5.44, 95% CI 1.67–17.65, p = 0.005) and para-aortic nodal metastasis (OR 6.98, 95% CI 1.81–26.78, p = 0.005), whereas focal LVSI was not significantly associated with either outcome. These findings suggest that the extent of LVSI may be relevant to nodal metastasis, with substantial LVSI showing a stronger association than focal LVSI. Full article

Background: Para-aortic lymph node involvement is present in approximately 17–24% of women with locally advanced cervical cancer (LACC) and is one of the strongest adverse prognostic factors in this population. Current international guidelines recommend two alternative staging techniques: the International Federation of Gynecology and Obstetrics (FIGO) and European Society of Gynecologic Oncology (ESGO) endorse imaging-based staging as the primary method to define radiation fields, whereas the National Comprehensive Cancer Network (NCCN) lists pre-treatment minimally invasive para-aortic lymphadenectomy as a Category 2B recommendation. Objective: We aimed to review and critically appraise the available evidence on the oncologic impact (progression-free and overall survival) of pre-treatment surgical para-aortic staging compared with clinical imaging-based staging in women with LACC. Methods: We searched MEDLINE (Ovid), Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Scopus from inception to January 2026, complemented by manually searching the reference lists for relevant articles and prior reviews. The review focused on comparative studies of women with LACC of squamous, adenocarcinoma, or adenosquamous histology—operationally defined as FIGO 2009 stages IB2–IVA with pelvic nodal involvement or FIGO 2018 stages IB3–IVA who received definitive-intent radiotherapy with or without concurrent chemotherapy and brachytherapy, and for whom comparative survival outcomes between a surgical-staging arm and an imaging-staging arm were reported. For this manuscript, a narrative review style was planned and reported in line with SANRA (Scale for the Assessment of Narrative Review Articles) quality criteria. Results: Twelve studies were included: two randomized controlled trials and ten observational studies (nine retrospective cohorts and one population-based analysis). Surgical staging consistently increased detection of occult para-aortic disease and led to more frequent use of extended-field radiotherapy (18–44%), but it did not yield a reproducible advantage in terms of progression-free or overall survival over imaging-guided chemoradiation. Conclusions: In LACC, pre-treatment surgical para-aortic staging improves anatomic and prognostic information but has not shown a consistent survival advantage over imaging-based staging combined with contemporary chemoradiation. Current comparative evidence does not support routine surgical staging, and its use still warrants further prospective evaluation in large clinical trials. Until results from ongoing phase III trials are available, surgical staging should be considered an individualized option in highly selected cases within multidisciplinary decision-making at experienced clinical centers. Full article

Background/Objectives: Systematic lymphadenectomy is recommended in apparent early-stage epithelial ovarian cancer (EOC) to assess nodal status, but it is associated with significant morbidity and lacks survival benefit. Sentinel lymph node (SLN) mapping may offer a less invasive alternative, although evidence remains limited due to the complexity of ovarian lymphatic drainage and methodological heterogeneity across studies. This prospective study evaluates the feasibility and diagnostic accuracy of a true hybrid ^99mTc–indocyanine green (ICG) tracer for SLN mapping in apparent early-stage EOC. Methods: A prospective observational study was conducted at a tertiary oncology center between 2021 and 2026. Patients presenting with a suspicious ovarian mass (Group A) or requiring restaging after adnexectomy for confirmed EOC (Group B) underwent SLN mapping using a hybrid ^99mTc–ICG tracer injected into the infundibulopelvic (IPL) and/or utero-ovarian ligament (UOL). SLNs were identified using gamma detection and near-infrared fluorescence imaging. All malignant cases underwent complete surgical staging including systematic pelvic and para-aortic lymphadenectomy. SLNs were ultrastaged and compared with the final nodal status. Results: Forty patients were included; 20 (50%) had malignant tumors. The overall SLN detection rate was 92.5% (37/40), with 100% in malignant cases. Among malignant tumors, 3/20 (15%) had metastatic SLNs, all accurately detected (false-negative rate 0%). Sensitivity and negative predictive value were 100%. Combined pelvic and para-aortic drainage was the most frequent pattern (75%). Conclusions: SLN mapping may represent a feasible and potentially accurate staging strategy in apparent early-stage EOC. In the present study, a hybrid ^99mTc–ICG tracer was associated with high detection rates and complete concordance with final nodal status. These findings support further multicenter validation to define its potential role as an alternative to systematic lymphadenectomy. Full article

Background: Clear cell renal cell carcinoma (ccRCC) constitutes 75–80% of all renal cell carcinomas and exhibits aggressive behavior with high metastatic potential. Common metastatic sites include lungs, bones, lymph nodes, and liver, while urinary bladder involvement is exceedingly rare. Early detection of atypical metastases is critical for risk stratification, surgical planning, and systemic therapy selection. Methods: We report a 69-year-old male presenting with recurrent, painless gross hematuria and dysuria. Contrast-enhanced computed tomography revealed a left renal mass with bilateral pulmonary nodules, regional lymphadenopathy, and a bladder lesion. The patient underwent transurethral resection (TUR) of the bladder lesion, followed by robot-assisted left nephro-adrenalectomy with para-aortic lymphadenectomy. Histopathology and immunohistochemistry (PAX8+, CD10+, CAIX+, CK7−, GATA3−) confirmed ccRCC with synchronous bladder metastasis. Postoperatively, combined immune checkpoint inhibitor (ICI) therapy and tyrosine kinase inhibitors (TKIs) were initiated. Results: TUR provided symptomatic relief and diagnostic confirmation. Robot-assisted surgery enabled precise, oncologically safe excision of the primary tumor and regional metastases with minimal blood loss and no perioperative complications. Pathological staging was pT3aN1M1, ISUP grade 2, with lymphovascular invasion, confirming advanced disease requiring systemic therapy. Early initiation of ICI plus TKI therapy targeted residual micrometastases to potentially prolong survival. Conclusions: This case highlights the rare occurrence of ccRCC with synchronous bladder metastasis and underscores the importance of comprehensive imaging, detailed morphologic and immunohistochemical evaluation, and a multidisciplinary approach. Robot-assisted cytoreductive surgery combined with modern systemic therapy represents an effective strategy for advanced ccRCC, emphasizing the need for individualized treatment and long-term follow-up in atypical metastatic scenarios. Full article

Background and Objectives: The prognostic significance of pelvic lymph node (PLN) count in surgically staged endometrial cancer remains controversial. This study aimed to evaluate the impact of PLN count on overall survival (OS), disease-free survival (DFS), and recurrence patterns in a large cohort of patients with endometrial cancer. Materials and Methods: This retrospective cohort study included 560 patients with endometrial cancer who underwent total hysterectomy, bilateral salpingo-oophorectomy, and pelvic and/or para-aortic lymph node assessment between January 2005 and May 2025 at a tertiary referral center. Patients were stratified according to the number of harvested pelvic lymph nodes (≤20 vs. >20). Clinicopathological characteristics, adjuvant treatments, recurrence patterns, and survival outcomes were analyzed. Survival analyses were performed using Kaplan–Meier estimates and Cox proportional hazards regression models. Results: Of the 560 patients, 262 (46.8%) had ≤20 pelvic lymph nodes harvested and 298 (53.2%) had >20. The median follow-up duration was 64.5 months. Patients with >20 pelvic lymph nodes had larger tumors, higher FIGO stage, and more frequent para-aortic lymphadenectomy. In multivariate analysis, age, non-endometrioid histology, advanced FIGO stage, tumor grade, and lymphatic metastasis were independently associated with both OS and DFS. Pelvic lymph node count was not independently associated with OS or DFS. Overall recurrence rates were similar between groups; however, recurrence patterns differed significantly, with distant recurrences more frequent in the ≤20 PLN group and local recurrences more common in the >20 PLN group. Conclusions: In surgically staged endometrial cancer, a higher pelvic lymph node count (>20 nodes) was not independently associated with survival or recurrence outcomes after adjustment for established prognostic factors, although recurrence patterns differed between groups. Survival was primarily determined by age, histologic subtype, FIGO stage, tumor grade, and lymphatic metastasis. Pelvic lymph node count appears to reflect surgical staging intensity and intraoperative risk assessment rather than serving as an independent determinant of prognosis. Full article

Objective: We investigated the relationship between venous thromboembolism (VTE) and pelvic and para-aortic lymphadenectomy (LND) within the first 90 days post gynaecological cancer surgery. Methods: A retrospective cohort analysis was conducted on 1021 patients who underwent gynaecological cancer surgery between 2006 and 2019. Univariate and multivariate analysis was performed to assess the effects of LND and lymph node (LN) metastasis on VTE occurrence within 90 days post-surgery. Results: A total of 41 patients developed VTE within 90 days post-surgery. Para-aortic LND was significantly associated with VTE (p < 0.001), with the highest rates (14.6%) observed in patients who had >10 para-aortic LN removed. In patients with pelvic LN metastasis, 10 (7.5%) developed VTE; patients with >5 pelvic nodes positive for metastasis had an HR = 4.83 (95% CI: 0.99–13.9) after adjustment for age, duration of hospital stay, and surgical approach. The highest VTE rates (27.3%) occurred in patients with >5 para-aortic LN positive for metastasis, HR = 3.79 (95% CI 1.44–14.23) after adjustment for age, duration of hospital stay, and surgical approach (p = 0.011). Conclusions: Para-aortic LND significantly increases VTE risk within the first 90 days post-surgery. The risk is further amplified in cases with metastatic LN and persists even after adjustment for other risk factors for VTE. While extended thromboprophylaxis is standard for all cancer patients, our findings suggest that para-aortic LND—especially with nodal metastases—may help identify those who would benefit most from a more tailored, risk-based prophylaxis approach. Full article

Background and Objectives: Para-aortic lymph node involvement is a key prognostic factor in high-risk endometrial cancer. This study aimed to identify factors associated with para-aortic lymph node metastasis and to assess their predictive value for surgical decision-making. Materials and Methods: A retrospective analysis was conducted on 81 patients with high-risk endometrial cancer who underwent systematic pelvic and para-aortic lymphadenectomy between January 2015 and December 2024. Factors evaluated included histologic subtype, lymphovascular space invasion (LVSI), cervical stromal involvement, depth of myometrial invasion, and tumor diameter. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of para-aortic metastasis. Receiver operating characteristic (ROC) analysis was used to determine the optimal tumor size threshold. Results: Para-aortic lymph node metastasis was identified in 21.0% of patients, and isolated para-aortic metastasis was observed in 2.5%. In univariate analysis, pelvic lymph node positivity, LVSI, cervical stromal invasion, deep myometrial invasion, and tumor size ≥ 3.55 cm were significantly associated with para-aortic spread. Multivariate analysis revealed that pelvic lymph node positivity was the only independent predictor (OR 39.0; 95% CI 5.06–301.46; p < 0.001). Conclusions: Pelvic lymph node status serves as a strong and independent predictor of para-aortic metastasis in high-risk endometrial cancer. A tumor diameter greater than 3.5 cm may also indicate an increased risk of para-aortic spread. These findings suggest that selective and individualized para-aortic assessment strategies may be considered to improve staging accuracy and optimize surgical planning in this patient population. Full article

The vascular anatomy of the stomach is both complex and highly variable, with direct implications for oncologic, bariatric, esophageal, and interventional procedures. This comprehensive review combines anatomical, radiological, and surgical evidence on arterial and venous variations in the stomach. The left gastric artery, traditionally the first branch of the coeliac trunk, often shows variants such as a direct aortic origin or association with an abnormal left hepatic artery. The right gastric artery most frequently arises from the proper hepatic artery, but its origin can vary significantly. The gastroepiploic arteries exhibit diversity in their origin, size, and connection patterns, with occasional duplication or absence. Additional vessels, including the posterior gastric artery and the short gastric arteries, also contribute to variations in arterial supply. Venous drainage largely follows the arterial pattern. The left and right gastric veins and the gastroepiploic venous arcade are major routes, while variants of the left gastric vein and the gastrocolic trunk (Henle’s trunk) contribute to complexity through different convergence patterns. These vascular variations have significant clinical implications, as they impact the safety of D2 lymphadenectomy, the risk of ischemic complications during laparoscopic sleeve gastrectomy, the success of gastric conduit formation in esophagectomy, and the effectiveness of transarterial embolization for upper gastrointestinal bleeding. Preoperative vascular mapping with multidetector computed tomography angiography and 3D reconstruction reliably defines individual anatomy, allowing for customized surgical planning and reducing operative risks. Recognizing both common and rare gastric vascular variants is essential for safe and effective surgical and endovascular management of gastric disease. Full article

Background: To identify prognostic factors related to survival in patients with early-stage cervical cancer treated with radical surgery in six high-volume gynecologic oncology centers in Turkey. Methods: This retrospective analysis examined a cohort of 612 patients diagnosed with cervical cancer who underwent type II/III radical hysterectomy and pelvic lymphadenectomy, with or without para-aortic lymphadenectomy at six gynecologic oncology centers. A total of 537 patients between 1993 and 2023 were included. According to the 2009 FIGO staging system, 411 patients (76.5%) were stage IB1, 76 (14.2%) were stage IB2, 40 (4.7%) were stage IIA1, and 10 (1.9%) were stage IIA2. Patients underwent either type II or type III radical hysterectomy with pelvic lymphadenectomy, with para-aortic lymphadenectomy performed in 93.1% of cases. Among the 537 patients, 258 (48%) underwent type II radical hysterectomy and 279 (52%) underwent type III. Univariate and multivariate analyses of 5-year overall survival (OS) and 5-year disease-free survival (DFS) were performed. Results: In the entire cohort, 258 (48%) patients underwent radical surgery alone, while 279 (52%) patients underwent radical surgery followed by adjuvant therapy. The 5-year DFS and 5-year OS rates were 85.3% and 98.4%, respectively. In the multivariate logistic analysis, lymph node metastasis was identified as an independent prognostic factor for DFS and OS. Conclusions: Lymph node metastasis was the most important prognostic factor for survival in this large multicenter Turkish cohort. These findings highlight the prognostic value of nodal status, stromal invasion, margin status, and LVSI, while underscoring the importance of tailored adjuvant treatment strategies. Full article

Background/Objectives: This study aims to critically appraise the role of para-aortic surgical staging in locally advanced cervical cancer (LACC) in the era of advanced imaging, and to outline how selective surgery and biomarkers could be integrated within modern, quality-assured treatment pathways. Methods: Narrative review of randomized trials, large databases, and prospective/retrospective series comparing para-aortic lymphadenectomy with imaging-based staging; focused appraisal of Uterus-11, NCDB analyses, and ongoing prospective trials (PAROLA with Senti-PAROLA as one of its sub-studies and PALDISC). Emerging technologies (PET/MRI, radiomics/AI) and molecular assays (OSNA, HPV-ctDNA) were also assessed. Results: PET/CT remains the standard for distant staging, but sensitivity for low-volume nodal disease (<5 mm) is poor; in pelvic-positive/para-aortic-negative patients, occult para-aortic metastases approach ~21%. Para-aortic surgical staging modifies radiotherapy planning in ~18% of cases and can act as a de-escalation tool by avoiding unnecessary extended-field CRT (EF-CRT) when para-aortic nodes are negative. Uterus-11 showed no overall survival difference versus CT-based staging, but suggested benefit in FIGO 2009 stage IIB; its design (CT comparator, optimistic assumptions, limited power) constrains inference. Minimally invasive extraperitoneal/transperitoneal staging is feasible with low morbidity in expert centers, yet real-world management may worsen outcomes. The role of systemic intensification in node-positive disease remains undefined: PALN-positive patients were excluded from the INTERLACE trial. In the KEYNOTE-826 study, subgroup analyses according to nodal status were not reported, although the benefit of pembrolizumab remained consistent irrespective of bevacizumab use. Sentinel para-aortic mapping and biomarkers (e.g., HPV-ctDNA) may refine selection and reduce morbidity. Conclusions: Surgical staging is the most accurate method to detect occult para-aortic disease. Its routine use is not justified, but it may benefit selected high-risk patients, particularly where decisions on EF-CRT or systemic therapy hinge on para-aortic status. Future practice should integrate advanced imaging, selective surgery, and biomarkers within accredited centers, guided by large collaborative trials conducted under international quality frameworks such as ESGO/ESTRO/ESP guidelines. Full article

Background and Objectives: Minimally invasive surgery is considered the standard of care for early-stage endometrial cancer. However, the oncological safety of intrauterine manipulator (IUM) use during laparoscopic hysterectomy remains controversial. The aim of this study was to evaluate the impact of intrauterine manipulator use during laparoscopic hysterectomy on oncological outcomes in patients with clinically early-stage endometrial cancer. Materials and Methods: In this retrospective cohort study, 612 patients with FIGO 2009 stage I–III endometrial cancer who underwent staging surgery at a tertiary center between January 2010 and May 2025 were included. Clinical and pathological characteristics were compared between laparoscopy (n = 168) and laparotomy (n = 444). To reduce selection bias, propensity score matching (PSM) was performed based on age, histological subtype, and FIGO stage. Kaplan–Meier survival analysis and Cox regression modeling were utilized to evaluate disease-free survival (DFS) and overall survival (OS). Results: After matching, groups were balanced except for higher rates of para-aortic lymphadenectomy and adjuvant therapy in the laparotomy group. IUM use was not associated with increased LVSI or positive peritoneal cytology. Recurrence was more frequent after laparoscopy (10.1% vs. 6.0%, p = 0.028), with inferior 5-year DFS (87.6% vs. 97.4%, HR 5.60, p = 0.0006), while OS was similar (82.0% vs. 87.6%, p = 0.842). In multivariate Cox analysis, independent predictors of worse DFS were non-endometrioid histology (HR 3.57), FIGO stage III (HR 3.06), grade 3 tumors (HR 2.63), and laparoscopic surgery (HR 0.51). For OS, non-endometrioid histology (HR 5.12), stage III disease (HR 2.98), and grade 3 tumors (HR 4.51) were independent adverse factors, whereas surgical approach was not. Conclusions: The use of an intrauterine manipulator in laparoscopic hysterectomy for early-stage endometrial cancer was linked to worse DFS but not OS. These findings suggest caution regarding the routine use of IUMs and highlight the need for prospective randomized trials to clarify their oncological safety. Full article

Background and Objectives: The causes and clinical outcomes of renal perfusion abnormalities occurring after para-aortic lymphadenectomy (PANDx) for gynecologic malignancies are unknown. We investigated the potential involvement of accessory renal artery (ARA) obstruction in their development by reassessing perioperative contrast-enhanced computed tomography (CECT). Materials and Methods: This retrospective study investigated a clinical database to identify urinary contrast defects using CECT in all patients who had undergone PANDx between January 2020 and December 2024. The perfusion defects in the kidney detected by CECT were extracted by a gynecologic oncologist and evaluated by a radiologist and urologist for suspected obstruction of ARAs. Results: Postoperative renal contrast defects were observed in 3.8% (6/157) of patients. Renal parenchymal fibrosis, cortical atrophy, and parenchymal thinning were observed as universal findings in all patients showing renal contrast defects. In five of the six cases, ARAs supplying the infarcted renal segments were identified on preoperative CECT, and arterial obstruction was confirmed on postoperative imaging. The remaining case was considered to be latent pyelonephritis. All five patients underwent laparotomy, and preoperative CECT failed to detect ARAs. The median resected para-aortic lymph node was 23 nodes (range: 15–33) in five patients, showing no statistically significant difference compared to patients without perfusion abnormalities (p = 0.19). Postoperative serum creatinine levels remained stable. Conclusions: ARA obstruction appears to be a risk factor for segmental renal infarction after para-aortic lymphadenectomy in gynecological malignancies; however, the clinical impact on urinary function may be limited. Awareness of this potential complication is essential for gynecologic oncologists performing PANDx. Full article

Background and Objectives: The therapeutic effect of para-aortic lymphadenectomy in patients with clinically para-aortic node-negative diseases remains controversial. In this study, we investigated whether combined pelvic and para-aortic lymphadenectomy has a survival benefit compared with pelvic lymphadenectomy alone in patients with clinically FIGO stage IIIC1 high-grade endometrial cancer. Materials and Methods: We retrospectively reviewed patients with clinically FIGO stage IIIC1 high-grade endometrial cancer in the period between January 2000 and December 2020 at two tertiary centers. The patients were stratified according to type of lymphadenectomy and subgroup analyses performed. Kaplan–Meier analysis and a Cox proportional-hazards model were used to evaluate survival outcomes. Results: A total of 56 patients were identified. Of these patients, 18 underwent pelvic lymphadenectomy alone and 38 underwent combined pelvic and para-aortic lymphadenectomy. After staging surgery, 34 (60.7%) patients had pathologically confirmed lymph node metastases. Within a median follow-up of 57.5 months, there were no significant differences in recurrence-free survival (RFS) and overall survival (OS) between the two groups. In subgroup analyses, the node- and lymphovascular space invasion (LVSI)-positive patients characterized by grade 3 endometrioid histologic type (p = 0.010) or negative peritoneal washing cytology (p = 0.035) had an RFS benefit from combined pelvic and para-aortic lymphadenectomy. Conclusions: The addition of para-aortic lymphadenectomy to pelvic lymphadenectomy did not improve survival in patients with clinically FIGO IIIC1 endometrial cancer. However, para-aortic lymphadenectomy may have RFS benefit for patients with grade 3 endometrioid histologic type and positive LVSI. Full article

Patients with a BRCA1 germline mutation often represent a challenge for medical healthcare, since they develop malignancies that tend to be more aggressive and which need to be addressed in multidisciplinary teams with more individualized therapies. We report a case of a 37-year-old woman with a BRCA1 mutation who was diagnosed and treated for high-grade papillary serous carcinoma of the fallopian tube. Eight years later, her regular check-up imaging revealed a latero-aortic lymphadenopathy and a right breast tumor. She underwent a fine needle breast biopsy which was positive for invasive non-specific type carcinoma with negative estrogen, progesterone and Her2 receptors in immunohistochemistry tests. The patient underwent debulking surgery for metastatic lymphadenopathy, followed by chemotherapy with Carboplatin and Paclitaxel, and a modified right mastectomy with axillary lymphadenectomy. She subsequently initiated therapy with the PARP inhibitor Olaparib. No evidence of tumor recurrence was detected during the six-month postoperative follow-up period. The primary goal of this paper is to emphasize the complexity and challenges of managing patients with BRCA1 mutations who develop synchronous malignancies. This case report aims to highlight the increasing role of precision medicine and the importance of personalized, multidisciplinary therapeutic strategies, which include surgery, chemotherapy, and targeted therapies. Full article

Background/Objectives: Cervical cancer primarily disseminates through the lymphatic system, with the metastatic involvement of pelvic and para-aortic lymph nodes significantly impacting prognosis and treatment decisions. Sentinel lymph node (SLN) mapping is critical in guiding surgical management. However, resource-limited settings often lack advanced detection tools like indocyanine green (ICG). This study evaluated the feasibility and effectiveness of SLN biopsy using alternative techniques in a high-risk population with a high prevalence of large tumours. Methods: This prospective, observational study included 42 patients with FIGO 2018 stage IA1–IIA1 cervical cancer treated between November 2019 and April 2024. SLN mapping was performed using methylene blue alone or combined with a technetium-99m radiotracer. Detection rates, sensitivity, and false-negative rates were analysed. Additional endpoints included tracer technique comparisons, SLN localization patterns, and factors influencing detection success. Results: SLNs were identified in 78.6% of cases, with bilateral detection in 57.1%. The combined technique yielded higher detection rates (93.3% overall, 80% bilateral) compared to methylene blue alone (70.4% overall, 40.7% bilateral, p < 0.05). The sensitivity and negative predictive values were 70% and 93.87%, respectively. Larger tumours (>4 cm), deep stromal invasion, and prior conization negatively impacted detection rates. False-negative SLNs were associated with larger tumours and positive lymphovascular space invasion. Conclusions: SLN biopsy is feasible in resource-limited settings, with improved detection rates using combined tracer techniques. However, sensitivity remains suboptimal due to a steep learning curve and challenges in high-risk patients. Until a high detection accuracy is achieved, SLN mapping should complement, rather than replace, pelvic lymphadenectomy in high-risk cases. Full article