The role of sentinel lymph nodes in endometrial and cervical cancer

Abstract

Sentinel lymph node assessment aims to determine lymphatic spread while preventing unnecessary interventions and morbidity for those who will not benefit from lymphadenectomy. All detection methods have demonstrated reasonable sensitivity with a low false negative rate and high negative predictive value; as long as the surgeon removes all enlarged lymph nodes and a site-specific lymphadenectomy is performed if there is no mapping. The significance of micrometastases and long term outcomes are yet to be determined.

Lower Body Lymphedema in Patients with Gynecologic Cancer

“…Instead, its application in gynecologic oncology remains still controversial: SLN biopsy is a safe and accepted alternative to inguinal femoral lymphadenectomy in selected women with squamous early-stage (<4 cm) unifocal vulvar cancer with no suspicious enlarged lymph nodes at imaging (9). Several studies have demonstrated feasibility with high detection rates and low false negative rates in appropriately selected patients with CC or EC (68).…”

Utilization of sentinel lymph node biopsy for uterine cancer

“…8,11 Given that endometrial tumors are not readily visualized prior to hysterectomy, the optimal injection site for SLN mapping remains uncertain. 11,12 While cervical injection is most commonly used, some studies have also used hysteroscopic localization or injection of the uterine fundus. 11,12 While many studies have used a combination of blue dye and technetium-99, the optimal dye or combination is uncertain.…”

“…7–10 The principle of SLN biopsy relies on removal of a small number of lymph nodes that are the first drainage basins from a tumor and thus the most likely to harbor tumor cells. 11,12 SLN biopsy has been extensively validated for a number of other solid tumors and is now in the standard of care in breast cancer, vulvar cancer, and melanoma. 13–15 …”

“…While some studies have examined the performance of SLN biopsy compared to lymphadenectomy, whether SLN biopsy can be used in lieu of lymphadenectomy and in which patients is unknown. 11 Further, as randomized trials have been unable to demonstrate a survival benefit even with full lymphadenectomy, some have questioned why SLN biopsy would be utilized at all for apparent early-stage endometrial cancer. 5,6 Given the limited data and uncertainty surrounding SLN biopsy for endometrial cancer, we examined the patterns and predictors of use of SLN biopsy in women with newly diagnosed endometrial cancer undergoing surgery.…”

Metastasierung von Malignomen des Uterus und therapeutische Konsequenzen

“…Ein pathologisches Ultrastaging mit Anfertigung von Stufenserien bringt wesentliche Informationen durch die Entdeckung von Mikrometastasen, die wahrscheinlich prognostische Bedeutung besitzen [13]. Die Erfahrungen beim Endometriumkarzinom sind aber weitaus valider [43]. Erfahrungen für Adenokarzinome der Zervix liegen nicht vor.…”