Endometrial cancer is the most common gynecological malignancy affecting women in Western countries [1,2]. In apparent early-stage disease, surgical staging with lymph node assessment helps guide clinical decision-making for adjuvant therapy and estimates risk of recurrence. Traditionally, full lymphadenectomy was recommended, but over the last few years, the landscape of endometrial cancer treatment has changed [3]. After several studies have demonstrated that sentinel lymph node (SLN) biopsy is safe, feasible and leads to fewer perioperative complications, it is now considered standard of care in apparent early-stage endometrial cancer [1,[4], [5], [6], [7], [8]]. SLN biopsy allows for pathological ultrastaging and immunohistochemistry staining which has increased the detection rate of lymph node metastases, namely micrometastases and isolated tumor cells (ITCs). While the mapping technique and detection of low volume metastases have been around for over two decades, there is paucity of literature regarding the clinical impact of low volume lymph node metastases, especially in the setting of ITCs [[9], [10], [11]]. Although the literature underlines the effectiveness of SLN biopsy in endometrial cancer, little is known of how these paradigm shifts in clinical practice have impacted patient outcomes. The purpose of this study is to gain a deeper understanding of the impact SLN biopsy has had on endometrial cancer treatment and outcomes by describing detection and recurrence rates, as well as our experience with micrometastases and ITCs. Our goal is to share our experience and provide a real-world view of endometrial cancer treatment and outcomes in three large, international tertiary cancer care centers.