The Oncological Implication of Sentinel Lymph Node in Early Cervical Cancer: A Meta-Analysis of Oncological Outcomes and Type of Recurrences

Abstract

Background and Objectives: Pelvic lymphadenectomy has been associated with radical hysterectomy for the treatment of early Cervical Cancer (ECC) since 1905. However, some complications are related to this technique, such as lymphedema and nerve damage. In addition, its clinical role is controversial. For this reason, the sentinel lymph node (SLN) has found increasing use in clinical practice over time. Oncologic safety, however, is debated, and there is no clear evidence in the literature regarding this. Therefore, our meta-analysis aims to schematically analyze the current scientific evidence to investigate the non-inferiority of SLN versus PLND regarding oncologic outcomes. Materials and Methods: Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically searched the PubMed and Scopus databases in June 2022 since their early first publications. We made no restrictions on the country. We considered only studies entirely published in English. We included studies containing Disease-Free Survival (DFS), Overall Survival (OS), Recurrence Rate (RR), and site of recurrence data. We used comparative studies for meta-analysis. We registered this meta-analysis to the PROSPERO site for meta-analysis with protocol number CRD42022316650. Results: Twelve studies fulfilled inclusion criteria. The four comparative studies were enrolled in meta-analysis. Patients were analyzed concerning Sentinel Lymph Node Biopsy (SLN) and compared with Bilateral Pelvic Systematic Lymphadenectomy (PLND) in early-stage Cervical Cancer (ECC). Meta-analysis highlighted no differences in oncological safety between these two techniques, both in DFS and OS. Moreover, most of the sites of recurrences in the SLN group seemed not to be correlated with missed lymphadenectomy. Conclusions: Data in the literature do not seem to show clear oncologic inferiority of SLN over PLND. On the contrary, the higher detection rate of positive lymph nodes and the predominance of no lymph node recurrences give hope that this technique may equal PLND in oncologic terms, improving its morbidity profile.

Fertility-Sparing Treatment for Early-Stage Cervical Cancer ≥ 2 cm: Can One Still Effectively Become a Mother? A Systematic Review of Fertility Outcomes

“…Similarly, in patients with ECC ≥ 2 cm, the modalities of lymphadenectomy are also controversial. Despite the high risk of lymph node metastasis, using the sentinel lymph node (SLN) could minimize the risks of lymphadenectomy-related morbidity 37 , 38 and provide information on the presence or absence of micrometastases by ultrastaging. 39 The upstream intent would be to identify patients with positive lymph nodes to exclude them from the FST pathway, regardless of the ART or NACT approach.…”

Sentinel Lymph Node Staging in Early-Stage Cervical Cancer: A Comprehensive Review

“…Overall, SLNB, when adhering to the algorithm, offers higher negative predictive value (NPV), specificity, and sensitivity compared to imaging staging. Regarding the survival outcomes of SLNB vs. PLNB, no clear inferiority of the former was demonstrated by a systematic review and meta-analysis [ 21 ], while one systematic review [ 13 ] was retrieved that showed the high diagnostic accuracy in terms of NPV and sensitivity. Additionally, regarding the impact of low-volume disease, two retrospective cohort studies showed conflicting results, with micrometastases (MICs) being associated with increased and decreased survival rates [ 22 , 23 ].…”

“…A systematic review and meta-analysis was conducted to address this question, including four studies, of which one was prospective randomized multicentric study, while the remaining three were retrospective cohorts [ 21 ]. The meta-analysis encompassed 1952 patients of FIGO Stage IA1 to IIA, with 383 undergoing exclusively SLNB and 1569 undergoing PLND.…”

Sentinel Lymph Node Staging in Early-Stage Cervical Cancer: A Comprehensive Review

“…A systematic review and meta-analysis was conducted to address this question including 4 studies, of which one was prospective randomized multicentric study, while the remaining three were retrospective cohorts [21]. The meta-analysis encompassed 1,952 patients of FIGO Stage IA1 to IIA, with 383 undergoing exclusively SLNB and 1,569 undergoing PLND.…”