Skip to main content
SpringerLink
Log in

Utility of Sentinel Node Biopsy in Cervical Cancer

  • Chapter
  • First Online:
Uterine Cervical Cancer

  • 883 Accesses

Abstract

The sentinel node is defined as the first lymph node to receive drainage from the tumor. The stage at diagnosis and lymph node involvement in cervical cancer are the two most important prognostic factors. The lymph node state will not only define prognosis but also determine the treatment. The most recognized procedure to evaluate the lymph node status is the pelvic lymphadenectomy, which is not free of short- and long-term complications. Therefore, the applicability of sentinel node biopsy in cervical cancer has recently begun to be studied.

Many factors are involved in the sensitivity and specificity of this technique, such as the patient’s age, tumor size, surgeon’s experience, approach, substance used for mapping, and pathological analysis method. Different substances – traditionally blue dyes and radiotracer, alone or combined – have been used for the detection of the sentinel node, resulting in a better detection rate when used together. Radiotracers allow preoperative imaging, which may decrease surgery time. Recently, the indocyanine green technique (a fluorescent dye) has been developed in a way to allow for real-time imaging during surgery, demonstrating better overall and bilateral detection rates. The histological study is performed intraoperatively because it modifies the therapeutic attitude. With sentinel node biopsy, ultrastaging analysis can be performed to detect micrometastasis and isolated tumoral cells. In addition, the sentinel node has other advantages over the lymphadenectomy, such as the detection of lymph node in atypical locations and the possibility of detecting low tumor volume. Based on evidence to date, the 2015 edition of National Comprehensive Cancer Network includes node mapping in early-stage cervical cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Virchow R. Lecture IX: Pyanemia and leucocytosipathologicals. Cellular pathology as based upon physiology and history. New Cork: Dover Publ Inc; 1971. p. 221–9.

    Google Scholar 

  2. Braithwaite LR. The flow of lymph from ileocecal angle and its possible bearing on the cause of duodenal and gastric ulcer. Br J Surg. 1923;11:117–26.

    Google Scholar 

  3. Cabañas RM. Anatomy and biopsy of sentinel lymph nodes. Urol Clin North Am. 1992;19(2):267–76.

    PubMed  Google Scholar 

  4. Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, Foshag LJCA. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127(4):392–9.

    Article  CAS  PubMed  Google Scholar 

  5. Morton DL, Thompson JF, Essner R, Elashoff R, Stern SL, Nieweg OE, Multicenter Selective Lymphadenectomy Trial Group, et al. Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: a multicenter trial. Ann Surg. 1999;230(4):453–63; discussion 463–465

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Krag DN, Weaver DL, Alex JC, Fairbank JT. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol. 1993;2(6):335–9; discussion 340

    Article  CAS  PubMed  Google Scholar 

  7. Mansel RE, Fallowfield L, Kissin M, Goyal A, Newcombe RG, Dixon JM, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst. 2006;98(9):599–609.

    Article  PubMed  Google Scholar 

  8. Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. Sentinellymph- node biopsy as a staging procedure in breast cancer: update of a randomised controlled study. Lancet Oncol. 2006;7(12):983–90.

    Article  PubMed  Google Scholar 

  9. Levenback C, Burke TW, Morris M, Malpica A, Lucas KR, Gershenson DM. Potential applications of intraoperative lymphatic mapping in vulvar cancer. Gynecol Oncol. 1995;59(2):216–20.

    Article  CAS  PubMed  Google Scholar 

  10. Covens A, Vella ET, Kennedy EB, Reade CJ, Jimenez W, Le T. Sentinel lymph node biopsy in vulvar cancer: Systematic review, meta-analysis and guideline recommendations. Gynecol Oncol. 2015;137(2):351–61.

    Article  PubMed  Google Scholar 

  11. NCCN Clinical Practice Guidelines in Oncology. Cervical cancer, Version 3. 2019.

    Google Scholar 

  12. Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynecol Obstet. 2009;105(2):103–4.

    Article  Google Scholar 

  13. Eiriksson LR, Covens a. Sentinel lymph node mapping in cervical cancer: the future? BJOG. 2012;119(2):129–33.

    Article  CAS  PubMed  Google Scholar 

  14. Landoni F, Maneo A, Colombo A, Placa F, Milani R, Perego P, et al. Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet. 1997;350(9077):535–40.

    Article  CAS  PubMed  Google Scholar 

  15. Chung HH, Park N-H, Kim JW, Song Y-S, Chung J-K, Kang S-B. Role of integrated PET-CT in pelvic lymph node staging of cervical cancer before radical hysterectomy. Gynecol Obstet Investig. 2009;67(1):61–6.

    Article  Google Scholar 

  16. Dekindt C, Stoeckle E, Thomas L, Floquet A, Kind M, Brouste V, et al. Laparoscopic interiliacal lymphadenectomy in cancer of the uterine cervix: still the gold standard? A propos lymph node recurrences in 190 treated patients. J Gynecol Obstet Biol Reprod (Paris). 2005;34(5):473–80.

    Article  CAS  Google Scholar 

  17. Fresno S, Vidal H. Cirugía Ginecológica para residentes 2016. Ed SEGO (Spain). p. 155–174.

    Google Scholar 

  18. Altgassen C, Hertel H, Brandstädt A, Köhler C, Dürst M, Schneider A. Multicenter validation study of the sentinel lymph node concept in cervical cancer: AGO Study Group. J Clin Oncol. 2008;26(18):2943–51.

    Article  PubMed  Google Scholar 

  19. Pareja R, Rendón GJ, Sanz-Lomana CM, Monzón O, Ramirez PT. Surgical, oncological, and obstetrical outcomes after abdominal radical trachelectomy – a systematic literature review. Gynecol Oncol. 2013;131(1):77–82.

    Article  PubMed  Google Scholar 

  20. Du X-L, Sheng X-G, Jiang T, Li Q-S, Yu H, Pan C-X, et al. Sentinel lymph node biopsy as guidance for radical trachelectomy in young patients with early stage cervical cancer. BMC Cancer. 2011;11:157.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Dargent D, Martin X, Mathevet P. Laparoscopic assessment of the sentinel lymph node in early stage cervical cancer. Gynecol Oncol. 2000;79(3):411–5.

    Article  CAS  PubMed  Google Scholar 

  22. De Cicco C, Cremonesi M, Chinol M, Bartolomei M, Pizzamiglio M, Leonardi L, et al. Optimization of axillary lymphoscintigraphy to detect the sentinel node in breast cancer. Tumori. 1997;83(2):539–41.

    Article  PubMed  Google Scholar 

  23. Verheijen RH, Pijpers R, Van DPJ, Burger CW, Buist MR, Kenemans P. Sentinel node detection in cervical cancer. Obstet Gynecol. 2000;96(1):135–8.

    CAS  PubMed  Google Scholar 

  24. Plante M, Renaud M-C, Têtu B, Harel F, Roy M. Laparoscopic sentinel node mapping in early-stage cervical cancer. Gynecol Oncol. 2003;91(3):494–503.

    Article  CAS  PubMed  Google Scholar 

  25. Rob L, Strnad P, Robova H, Charvat M, Pluta M, Schlegerova D, et al. Study of lymphatic mapping and sentinel node identification in early stage cervical cancer. Gynecol Oncol. 2005;98(2):281–8.

    Article  PubMed  Google Scholar 

  26. Kadkhodayan S, Hasanzadeh M, Treglia G, et al. Sentinel node biopsy for lymph nodal staging of uterine cervix cancer: A systematic review and meta-analysis of the pertinent literature. Eur J Surg Oncol. 2015;41(1):1–20.

    Article  CAS  PubMed  Google Scholar 

  27. Fotiou S, Zarganis P, Vorgias G, Trivizaki E, Velentzas K, Akrivos T, et al. Clinical value of preoperative lymphoscintigraphy in patients with early cervical cancer considered for intraoperative lymphatic mapping. Anticancer Res. 2010;30(1):183–8.

    PubMed  Google Scholar 

  28. Bats A-S, Frati A, Mathevet P, Orliaguet I, Querleu D, Zerdoud S, et al. Contribution of lymphoscintigraphy to intraoperative sentinel lymph node detection in early cervical cancer: Analysis of the prospective multicenter SENTICOL cohort. Gynecol Oncol. 2015;137(2):264–9.

    Article  PubMed  Google Scholar 

  29. Klapdor R, Mücke J, Schneider M, Länger F, Gratz K-F, Hillemanns P, et al. Value and advantages of preoperative sentinel lymph node imaging with SPECT/CT in cervical cancer. Int J Gynecol Cancer. 2014;24(2):295–302.

    Article  PubMed  Google Scholar 

  30. Hoogendam JP, Hobbelink MG, Veldhuis WB, et al. Preoperative sentinel node mapping with (99m)Tc-nanocolloid SPECT-CT significantly reduces the intraoperative sentinel node retrieval time in robot assisted laparoscopic cervical cancer surgery. Gynecol Oncol. 2013;129:389–94.

    Article  PubMed  Google Scholar 

  31. Ruscito I, Gasparri ML, Braicu EI, et al. Sentinel node mapping in cervical and endometrial cancer: indocyanine green versus other conventional dyes-a meta-analysis. Ann Surg Oncol. 2016;23:3749–56.

    Article  PubMed  Google Scholar 

  32. Buda A, Papadia A, Zapardiel I, et al. From conventional radiotracer tc-99m with blue dye to indocyanine green fluorescence: a comparison of methods towards optimization of sentinel lymph node mapping in early stage cervical cancer for a laparoscopic approach. Ann Surg Oncol. 2016;23(9):2959–65.

    Article  PubMed  Google Scholar 

  33. Choi HJ, Kim TJ, Lee YY, et al. Time-lapse imaging of sentinel lymph node using indocyanine green with near-infrared fluorescence imaging in early endometrial cancer. J Gynecol Oncol. 2016;27:e27.

    Article  PubMed  CAS  Google Scholar 

  34. Rossi EC, Ivanova A, Boggess JF. Robotically assisted fluorescence-guided lymph node mapping with ICG for gynecologic malignancies: a feasibility study. Gynecol Oncol. 2012;124:78–82.

    Article  PubMed  Google Scholar 

  35. Schaafsma BE, van der Vorst JR, Gaarenstroom KN, et al. Randomized comparison of near-infrared fluorescence lymphatic tracers for sentinel lymph node mapping of cervical cancer. Gynecol Oncol. 2012;127:126–30.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Leong SP, Donegan E, Heffernon W, Dean S, Katz JA. Adverse reactions to isosulfan blue during selective sentinel lymph node dissection in melanoma. Ann Surg Oncol. 2000;7(5):361–6.

    Article  CAS  PubMed  Google Scholar 

  37. Wu Y, Li Z, Wu H, Yu J. Sentinel lymph node biopsy in cervical cancer: A metaanalysis. Mol Clin Oncol. 2013;1(6):1025–30.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Levenback C, Coleman RL, Burke TW, Lin WM, Erdman W, Deavers M, et al. Lymphatic mapping and sentinel node identification in patients with cervix cancer undergoing radical hysterectomy and pelvic lymphadenectomy. J Clin Oncol. 2002;20(3):688–93.

    Article  PubMed  Google Scholar 

  39. Hauspy J, Beiner M, Harley I, Ehrlich L, Rasty G, Covens A. Sentinel lymph nodes in early stage cervical cancer. Gynecol Oncol. 2007;105(2):285–90.

    Article  CAS  PubMed  Google Scholar 

  40. Lécuru F, Mathevet P, Querleu D, Leblanc E, Morice P, Daraï E, et al. Bilateral negative sentinel nodes accurately predict absence of lymph node metastasis in early cervical cancer: Results of the SENTICOL study. J Clin Oncol. 2011;29(13):1686–91.

    Article  PubMed  Google Scholar 

  41. Roy M, Bouchard-Fortier G, Popa I, Grégoire J, Renaud M-C, Têtu B, et al. Value of sentinel node mapping in cancer of the cervix. Gynecol Oncol. 2011;122(2):269–74.

    Article  PubMed  Google Scholar 

  42. Frumovitz M, Ramirez PT, Levenback CF. Lymphatic mapping and sentinel lymph node detection in women with cervical cancer. Gynecol Oncol. 2008;110(3 Suppl 2):S17–20.

    Article  PubMed  Google Scholar 

  43. Gien LT, Covens A, Oncology G, Health S, Centre S. Quality control in sentinel lymph node biopsy in cervical cancer. J Clin Oncol. 2008;26(18):2930–1.

    Article  PubMed  Google Scholar 

  44. Buist MR, Pijpers RJ, van Lingen A, van Diest PJ, Dijkstra J, Kenemans P, et al. Laparoscopic detection of sentinel lymph nodes followed by lymph node dissection in patients with early stage cervical cancer. Gynecol Oncol. 2003;90(2):290–6.

    Article  PubMed  Google Scholar 

  45. Gortzak-Uzan L, Jimenez W, Nofech-Mozes S, Ismiil N, Khalifa MA, Dubé V, et al. Sentinel lymph node biopsy vs. pelvic lymphadenectomy in early stage cervical cancer: is it time to change the gold standard? Gynecol Oncol. 2010;116(1):28–32.

    Article  CAS  PubMed  Google Scholar 

  46. Ouldamer L, Marret H, Acker O, Barillot I, Body G. Unusual localizations of sentinel lymph nodes in early stage cervical cancer: a review. Surg Oncol. 2012;21(3):153–7.

    Article  Google Scholar 

  47. Winter R, Haas J, Reich O, Koemetter R, Tamussino K, Lahousen M, et al. Parametrial spread of cervical cancer in patients with negative pelvic lymph nodes. Gynecol Oncol. 2002;84(2):252–7.

    Article  PubMed  Google Scholar 

  48. Covens A, Rosen B, Murphy J, Laframboise S, DePetrillo AD, Lickrish G, et al. How important is removal of the parametrium at surgery for carcinoma of the cervix? Gynecol Oncol. 2002;84(1):145–9.

    Article  CAS  PubMed  Google Scholar 

  49. Ramirez PT, Pareja R, Rendón GJ, Millan C, Frumovitz M, Schmeler KM. Management of low-risk early-stage cervical cancer: Should conization, simple trachelectomy, or simple hysterectomy replace radical surgery as the new standard of care? Gynecol Oncol. 2014;132(1):254–9.

    Article  PubMed  Google Scholar 

  50. Martínez A, Mery E, Filleron T, Boileau L, Ferron G, Querleu D. Accuracy of intraoperative pathological examination of SLN in cervical cancer. Gynecol Oncol. 2013;130(3):525–9.

    Article  PubMed  Google Scholar 

  51. Tax C, Rovers MM, Graaf C, et al. The sentinel node procedure in early stage cervical cancer, taking the next step; a diagnostic review. Gynec Oncol. 2015;139:559–67.

    Article  Google Scholar 

  52. Slama J, Dundr P, Dusek L, Cibula D. High false negative rate of frozen section examination of sentinel lymph nodes in patients with cervical cancer. Gynecol Oncol. 2013;129(2):384–8.

    Article  CAS  PubMed  Google Scholar 

  53. Barranger E, Grahek D, Cortez A, Talbot JN, Uzan S, Darai E. Laparoscopic sentinel lymph node procedure using a combination of patent blue and radioisotope in women with cervical carcinoma. Cancer. 2003;97(12):3003–9.

    Article  PubMed  Google Scholar 

  54. Horn LC, Hentschel B, Fischer U, Peter D, Bilek K. Detection of micrometastases in pelvic lymph nodes in patients with carcinoma of the cervix uteri using step sectioning: Frequency, topographic distribution and prognostic impact. Gynecol Oncol. 2008;111(2):276–81.

    Article  PubMed  Google Scholar 

  55. Cibula D, Abu-Rustum NR, Dusek L, Zikán M, Zaal a SL, et al. Prognostic significance of low volume sentinel lymph node disease in early-stage cervical cancer. Gynecol Oncol. 2012;124(3):496–501.

    Article  CAS  PubMed  Google Scholar 

  56. Wang HY, Sun JM, Lu HF, Shi DR, Ou ZL, Cancer RYLFS. Micrometastases detected by cytokeratin 19 expression in sentinel lymph nodes of patients with early cervical. Int J Gynecol Cancer. 2006;16(2):643–8.

    Article  CAS  PubMed  Google Scholar 

  57. Di Martino G, Crivellaro C, De Ponti E, et al. Indocyanine green versus radiotracer with or without blue dye for sentinel lymph node mapping in stage >IB1 cervical cancer (>2 cm). J Minim Invasive Gynecol. 2017;24:1–6.

    Article  Google Scholar 

  58. Liu KJ, Lv XW, Liu Q, et al. Application of carbon nanoparticles in the laparoscopic sentinel lymph node detection in patients with cervical cancer. Acta Acad Med Sin. 2013;35:150–4.

    CAS  Google Scholar 

  59. Paredes P, Vidal-Sicart S, Campos F et al.. Role of ICG-Tc99-nanocolloid for sentinel lymph node detection in cervical cancer: a pilot study. Eur J Nucl Med Mol Imaging. 2017;44(11):1853–61.

    Article  CAS  PubMed  Google Scholar 

  60. Reade CJ, Eiriksson LR, Covens A. Surgery for early stage cervical cancer: how radical should it be? Gynecol Oncol. 2013;131(1):222–30.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain

    Alejandra Mateos & Silvia Marín

  2. Gynecologic Oncology Unit, La Paz University Hospital-IdiPAZ, Madrid, Spain

    Ignacio Zapardiel

Authors
  1. Alejandra Mateos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Silvia Marín
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ignacio Zapardiel
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. The Joan and Sanford I. Weill Medical College/Graduate School of Medical Sciences, The New York Presbyterian Hospital-Weill Cornell Medical Center, and Sandra and Edward Meyer Cancer Center, Cornell University, New York, NY, USA

    Samir A. Farghaly

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Mateos, A., Marín, S., Zapardiel, I. (2019). Utility of Sentinel Node Biopsy in Cervical Cancer. In: Farghaly, S. (eds) Uterine Cervical Cancer. Springer, Cham. https://doi.org/10.1007/978-3-030-02701-8_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-02701-8_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-02700-1

  • Online ISBN: 978-3-030-02701-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation