Prognostic value of the SENTIREC-endo algorithm integrating sentinel lymph node and FDG-PET/CT in staging high-risk endometrial cancer

Jorun Holm; Sarah Marie Bjørnholt; Oke Gerke; Mie Holm Vilstrup; Annika Loft; André Henrique Dias; Doris Schledermann; Else Mejlgaard; Sara Elisabeth Sponholtz; Kirsten Marie Jochumsen; Malene Grubbe Hildebrandt; Pernille Tine Jensen

doi:10.1016/j.ejso.2026.111878

Prognostic value of the SENTIREC-endo algorithm integrating sentinel lymph node and FDG-PET/CT in staging high-risk endometrial cancer

Jorun Holm^*
, Sarah Marie Bjørnholt
, Oke Gerke
, Mie Holm Vilstrup
, Annika Loft
, André Henrique Dias
, Doris Schledermann
, Else Mejlgaard
, Sara Elisabeth Sponholtz
, Kirsten Marie Jochumsen
, Malene Grubbe Hildebrandt
, Pernille Tine Jensen

^*Kontaktforfatter

Aarhus Universitetshospital
Københavns Universitetshospital
Aarhus Universitet

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

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Abstract

Introduction: Lymph node metastasis is a significant negative prognostic factor in women with high-risk endometrial cancer. The SENTIREC-endo algorithm, combining sentinel lymph node mapping and FDG-PET/CT for targeted pelvic and paraaortic lymph node dissection has shown high diagnostic accuracy. This study investigated whether the SENTIREC-endo algorithm showed similar prognostic discrimination to systematic lymphadenectomy within the same cohort. Methods: In a prospective national non-randomized cohort (2017–2023), women with high-risk endometrial cancer underwent the SENTIREC-endo algorithm, including sentinel node mapping, resection of suspicious and/or FDG-PET-positive nodes, followed by systematic lymph node dissection. Within the cohort, we compared time to progression and mortality between node-positive and node-negative groups, as defined by the algorithm versus systematic dissection. We also assessed the prognostic value and diagnostic accuracy of lymphovascular space invasion (LVSI) and evaluated associated prognostic variables. Results: The SENTIREC-endo algorithm demonstrated significant discrimination in survival outcomes (p = 0.001), with Kaplan–Meier curves paralleling systematic lymphadenectomy, supporting its prognostic performance. LVSI showed a strong prognostic association (p = 0.0004) but low sensitivity for detection of nodal metastasis (38%, 95% CI 24–54%), suggesting prognostic independence from lymph node status. FDG-PET/CT combined with LVSI lacked sufficient prognostic accuracy to replace surgical staging. Conclusion: The SENTIREC-endo algorithm showed similar prognostic discrimination as systematic lymphadenectomy within the same cohort of high-risk endometrial cancer. LVSI remained an essential prognostic marker but was unsuitable for predicting nodal metastasis. Our findings support surgical lymph node dissection with validated targeted dissection should remain part of standard staging of women with high-risk endometrial cancer.

Originalsprog	Engelsk
Artikelnummer	111878
Tidsskrift	European Journal of Surgical Oncology
Vol/bind	52
Udgave nummer	7
Antal sider	8
ISSN	0748-7983
DOI	https://doi.org/10.1016/j.ejso.2026.111878
Status	Udgivet - jul. 2026

Finansiering

We are grateful to the Aarhus, Copenhagen and Odense University Hospitals making payments for local running costs of ultrastaging an PET/CT scans. The project was further funded by Odense University Hospitals Front Line Research Foundation, Odense University Hospitals Free Research Foundation, the Danish Cancer Research Fund, and the Vissing Foundation. The funding sources had no role in study design, data collection, analysis and interpretation of data, writing the manuscript, or in the decision to submit the paper for publication.

Dokumenter og links

10.1016/j.ejso.2026.111878Licens: CC BY

Open Access VersionForlagets udgivne version, 3,75 MBLicens: CC BY

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Citationsformater

Holm, J., Bjørnholt, S. M., Gerke, O., Vilstrup, M. H., Loft, A., Dias, A. H., Schledermann, D., Mejlgaard, E., Sponholtz, S. E., Jochumsen, K. M., Hildebrandt, M. G., & Jensen, P. T. (2026). Prognostic value of the SENTIREC-endo algorithm integrating sentinel lymph node and FDG-PET/CT in staging high-risk endometrial cancer. European Journal of Surgical Oncology, 52(7), Artikel 111878. https://doi.org/10.1016/j.ejso.2026.111878

@article{a48e5f0858114fb5b9aa1f63aa958dcd,

title = "Prognostic value of the SENTIREC-endo algorithm integrating sentinel lymph node and FDG-PET/CT in staging high-risk endometrial cancer",

abstract = "Introduction: Lymph node metastasis is a significant negative prognostic factor in women with high-risk endometrial cancer. The SENTIREC-endo algorithm, combining sentinel lymph node mapping and FDG-PET/CT for targeted pelvic and paraaortic lymph node dissection has shown high diagnostic accuracy. This study investigated whether the SENTIREC-endo algorithm showed similar prognostic discrimination to systematic lymphadenectomy within the same cohort. Methods: In a prospective national non-randomized cohort (2017–2023), women with high-risk endometrial cancer underwent the SENTIREC-endo algorithm, including sentinel node mapping, resection of suspicious and/or FDG-PET-positive nodes, followed by systematic lymph node dissection. Within the cohort, we compared time to progression and mortality between node-positive and node-negative groups, as defined by the algorithm versus systematic dissection. We also assessed the prognostic value and diagnostic accuracy of lymphovascular space invasion (LVSI) and evaluated associated prognostic variables. Results: The SENTIREC-endo algorithm demonstrated significant discrimination in survival outcomes (p = 0.001), with Kaplan–Meier curves paralleling systematic lymphadenectomy, supporting its prognostic performance. LVSI showed a strong prognostic association (p = 0.0004) but low sensitivity for detection of nodal metastasis (38\%, 95\% CI 24–54\%), suggesting prognostic independence from lymph node status. FDG-PET/CT combined with LVSI lacked sufficient prognostic accuracy to replace surgical staging. Conclusion: The SENTIREC-endo algorithm showed similar prognostic discrimination as systematic lymphadenectomy within the same cohort of high-risk endometrial cancer. LVSI remained an essential prognostic marker but was unsuitable for predicting nodal metastasis. Our findings support surgical lymph node dissection with validated targeted dissection should remain part of standard staging of women with high-risk endometrial cancer.",

keywords = "Endometrial cancer, FDG-PET/CT, LVSI, Prognostic, Sentinel lymph node, Survival",

author = "Jorun Holm and Bj{\o}rnholt, \{Sarah Marie\} and Oke Gerke and Vilstrup, \{Mie Holm\} and Annika Loft and Dias, \{Andr{\'e} Henrique\} and Doris Schledermann and Else Mejlgaard and Sponholtz, \{Sara Elisabeth\} and Jochumsen, \{Kirsten Marie\} and Hildebrandt, \{Malene Grubbe\} and Jensen, \{Pernille Tine\}",

year = "2026",

month = jul,

doi = "10.1016/j.ejso.2026.111878",

language = "English",

volume = "52",

journal = "European Journal of Surgical Oncology",

issn = "0748-7983",

publisher = "Elsevier",

number = "7",

}

Holm, J, Bjørnholt, SM, Gerke, O , Vilstrup, MH, Loft, A, Dias, AH, Schledermann, D, Mejlgaard, E, Sponholtz, SE, Jochumsen, KM , Hildebrandt, MG & Jensen, PT 2026, 'Prognostic value of the SENTIREC-endo algorithm integrating sentinel lymph node and FDG-PET/CT in staging high-risk endometrial cancer', European Journal of Surgical Oncology, bind 52, nr. 7, 111878. https://doi.org/10.1016/j.ejso.2026.111878

TY - JOUR

T1 - Prognostic value of the SENTIREC-endo algorithm integrating sentinel lymph node and FDG-PET/CT in staging high-risk endometrial cancer

AU - Holm, Jorun

AU - Bjørnholt, Sarah Marie

AU - Gerke, Oke

AU - Vilstrup, Mie Holm

AU - Loft, Annika

AU - Dias, André Henrique

AU - Schledermann, Doris

AU - Mejlgaard, Else

AU - Sponholtz, Sara Elisabeth

AU - Jochumsen, Kirsten Marie

AU - Hildebrandt, Malene Grubbe

AU - Jensen, Pernille Tine

PY - 2026/7

Y1 - 2026/7

N2 - Introduction: Lymph node metastasis is a significant negative prognostic factor in women with high-risk endometrial cancer. The SENTIREC-endo algorithm, combining sentinel lymph node mapping and FDG-PET/CT for targeted pelvic and paraaortic lymph node dissection has shown high diagnostic accuracy. This study investigated whether the SENTIREC-endo algorithm showed similar prognostic discrimination to systematic lymphadenectomy within the same cohort. Methods: In a prospective national non-randomized cohort (2017–2023), women with high-risk endometrial cancer underwent the SENTIREC-endo algorithm, including sentinel node mapping, resection of suspicious and/or FDG-PET-positive nodes, followed by systematic lymph node dissection. Within the cohort, we compared time to progression and mortality between node-positive and node-negative groups, as defined by the algorithm versus systematic dissection. We also assessed the prognostic value and diagnostic accuracy of lymphovascular space invasion (LVSI) and evaluated associated prognostic variables. Results: The SENTIREC-endo algorithm demonstrated significant discrimination in survival outcomes (p = 0.001), with Kaplan–Meier curves paralleling systematic lymphadenectomy, supporting its prognostic performance. LVSI showed a strong prognostic association (p = 0.0004) but low sensitivity for detection of nodal metastasis (38%, 95% CI 24–54%), suggesting prognostic independence from lymph node status. FDG-PET/CT combined with LVSI lacked sufficient prognostic accuracy to replace surgical staging. Conclusion: The SENTIREC-endo algorithm showed similar prognostic discrimination as systematic lymphadenectomy within the same cohort of high-risk endometrial cancer. LVSI remained an essential prognostic marker but was unsuitable for predicting nodal metastasis. Our findings support surgical lymph node dissection with validated targeted dissection should remain part of standard staging of women with high-risk endometrial cancer.

AB - Introduction: Lymph node metastasis is a significant negative prognostic factor in women with high-risk endometrial cancer. The SENTIREC-endo algorithm, combining sentinel lymph node mapping and FDG-PET/CT for targeted pelvic and paraaortic lymph node dissection has shown high diagnostic accuracy. This study investigated whether the SENTIREC-endo algorithm showed similar prognostic discrimination to systematic lymphadenectomy within the same cohort. Methods: In a prospective national non-randomized cohort (2017–2023), women with high-risk endometrial cancer underwent the SENTIREC-endo algorithm, including sentinel node mapping, resection of suspicious and/or FDG-PET-positive nodes, followed by systematic lymph node dissection. Within the cohort, we compared time to progression and mortality between node-positive and node-negative groups, as defined by the algorithm versus systematic dissection. We also assessed the prognostic value and diagnostic accuracy of lymphovascular space invasion (LVSI) and evaluated associated prognostic variables. Results: The SENTIREC-endo algorithm demonstrated significant discrimination in survival outcomes (p = 0.001), with Kaplan–Meier curves paralleling systematic lymphadenectomy, supporting its prognostic performance. LVSI showed a strong prognostic association (p = 0.0004) but low sensitivity for detection of nodal metastasis (38%, 95% CI 24–54%), suggesting prognostic independence from lymph node status. FDG-PET/CT combined with LVSI lacked sufficient prognostic accuracy to replace surgical staging. Conclusion: The SENTIREC-endo algorithm showed similar prognostic discrimination as systematic lymphadenectomy within the same cohort of high-risk endometrial cancer. LVSI remained an essential prognostic marker but was unsuitable for predicting nodal metastasis. Our findings support surgical lymph node dissection with validated targeted dissection should remain part of standard staging of women with high-risk endometrial cancer.

KW - Endometrial cancer

KW - FDG-PET/CT

KW - LVSI

KW - Prognostic

KW - Sentinel lymph node

KW - Survival

U2 - 10.1016/j.ejso.2026.111878

DO - 10.1016/j.ejso.2026.111878

M3 - Journal article

C2 - 42127608

AN - SCOPUS:105038626445

SN - 0748-7983

VL - 52

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

IS - 7

M1 - 111878

ER -

Prognostic value of the SENTIREC-endo algorithm integrating sentinel lymph node and FDG-PET/CT in staging high-risk endometrial cancer

Abstract

Finansiering

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