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Where Are We Going with Sentinel Lymph Node Mapping in Gynecologic Cancers?

  • Gynecologic Cancers (NS Reed, Section Editor)
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Current Oncology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Sentinel lymph node (SLN) mapping is a standard of care for lymphatic assessment of many early-stage gynecologic malignancies. We review the current data, emphasizing the utility of SLN mapping in the management of gynecologic cancers.

Recent Findings

Endometrial cancer: recent studies have focused on confirming the safety and efficacy of SLN mapping for high-risk patients. Cervical cancer: the LACC Trial demonstrated reduced survival with minimally invasive surgery, calling into question the validity of prior studies evaluating SLN mapping with a minimally invasive approach. Vulvar cancer: the ongoing GROINS-V-II trial is investigating whether patients with SLN metastasis < 2 mm in diameter can safely undergo adjuvant radiation ± chemotherapy without completion inguinal lymphadenectomy.

Summary

NCCN guidelines have incorporated SLN mapping as a lymphatic assessment strategy for endometrial, cervical, and vulvar malignancies. SLN mapping appears to reduce morbidity while still maintaining an appropriate detection rate of lymphatic metastasis. Additional clinical trials will further our knowledge of these procedures.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Cabanas RM. An approach for the treatment of penile carcinoma. Cancer. 1977;39(2):456–66.

    Article  CAS  PubMed  Google Scholar 

  2. Mocellin S, Hoon DSB, Pilati P, Rossi CR, Nitti D. Sentinel lymph node molecular ultrastaging in patients with melanoma: a systematic review and meta-analysis of prognosis. J Clin Oncol. 2007;25(12):1588–95.

    Article  PubMed  Google Scholar 

  3. Cody HS 3rd. Sentinel lymph node mapping in breast cancer. Breast Cancer. 1999;6(1):13–22.

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  5. National Comprehensive Cancer Network. Vulvar cancer (Version 1.2019). 2018. Available from: https://www.nccn.org/professionals/physician_gls/pdf/vulvar.pdf

  6. National Comprehensive Cancer Network. Cervical cancer (Version 1.2019). 2018. Available from: https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf

  7. National Comprehensive Cancer Network. Uterine neoplasms (Version 2.2018). 2018. Available from: https://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf

  8. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017;67(1):7–30.

    Article  PubMed  Google Scholar 

  9. Abu-Rustum NR. Sentinel lymph node mapping for endometrial cancer: a modern approach to surgical staging. J Natl Compr Cancer Netw. 2014;12(2):288–97.

    Article  Google Scholar 

  10. Kitchener H, Swart AMC, Qian Q, Amos C, Parmar MKB. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet (London, England). 2009;373(9658):125–36.

    Article  CAS  Google Scholar 

  11. Yost KJ, Cheville AL, Al-Hilli MM, Mariani A, Barrette BA, McGree ME, et al. Lymphedema after surgery for endometrial cancer: prevalence, risk factors, and quality of life. Obstet Gynecol. 2014;124(2 Pt 1):307–15.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Todo Y, Yamamoto R, Minobe S, Suzuki Y, Takeshi U, Nakatani M, et al. Risk factors for postoperative lower-extremity lymphedema in endometrial cancer survivors who had treatment including lymphadenectomy. Gynecol Oncol. 2010;119(1):60–4.

    Article  PubMed  Google Scholar 

  13. Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, Scambia G, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008;100(23):1707–16.

    Article  PubMed  Google Scholar 

  14. Case AS, Rocconi RP, Straughn JMJ, Conner M, Novak L, Wang W, et al. A prospective blinded evaluation of the accuracy of frozen section for the surgical management of endometrial cancer. Obstet Gynecol United States. 2006;108(6):1375–9.

    Article  Google Scholar 

  15. Kumar S, Bandyopadhyay S, Semaan A, Shah JP, Mahdi H, Morris R, et al. The role of frozen section in surgical staging of low risk endometrial cancer. PLoS One. 2011;6:e21912.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Mariani A, Dowdy SC, Cliby WA, Gostout BS, Jones MB, Wilson TO, et al. Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol. 2008;109:11–8.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Barlin JN, Khoury-Collado F, Kim CH, Leitao MM, Chi DS, Sonoda Y, et al. The importance of applying a sentinel lymph node mapping algorithm in endometrial cancer staging: beyond removal of blue nodes. Gynecol Oncol. 2012;125(3):531–5.

    Article  PubMed  Google Scholar 

  18. Sinno AK, Fader AN, Tanner EJ. Single site robotic sentinel lymph node biopsy and hysterectomy in endometrial cancer. Gynecol Oncol 2015;137(1).

  19. Sinno AK, Fader AN, Roche KL, Giuntoli II RL, Tanner EJ. A comparison of colorimetric versus fluorometric sentinel lymph node mapping during robotic surgery for endometrial cancer. Gynecol Oncol 2014;134(2).

  20. Torne A, Pahisa J, Vidal-Sicart S, Martinez-Roman S, Paredes P, Puerto B, et al. Transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR): a new method for sentinel lymph node detection in endometrial cancer. Gynecol Oncol. 2013;128(1):88–94.

    Article  PubMed  Google Scholar 

  21. Solima E, Martinelli F, Ditto A, Maccauro M, Carcangiu M, Mariani L, et al. Diagnostic accuracy of sentinel node in endometrial cancer by using hysteroscopic injection of radiolabeled tracer. Gynecol Oncol. 2012;126(3):419–23.

    Article  PubMed  Google Scholar 

  22. Kang S, Yoo HJ, Hwang JH, Lim M-C, Seo S-S, Park S-Y. Sentinel lymph node biopsy in endometrial cancer: meta-analysis of 26 studies. Gynecol Oncol. 2011;123(3):522–7.

    Article  PubMed  Google Scholar 

  23. Khoury-Collado F, Abu-Rustum NR. Lymphatic mapping in endometrial cancer: a literature review of current techniques and results. Int J Gynecol Cancer. 2008;18(6):1163–8.

    Article  CAS  PubMed  Google Scholar 

  24. Abu-Rustum NR, Khoury-Collado F, Gemignani ML. Techniques of sentinel lymph node identification for early-stage cervical and uterine cancer. Gynecol Oncol. 2008;111(2 Suppl):S44–50.

    Article  PubMed  Google Scholar 

  25. • Holloway RW, Abu-Rustum NR, Backes FJ, Boggess JF, Gotlieb WH, Jeffrey Lowery W, et al. Sentinel lymph node mapping and staging in endometrial cancer: a Society of Gynecologic Oncology literature review with consensus recommendations. Gynecol Oncol. 2017; Consensus statement from the SGO evaluating current controversies in SLN mapping for endometrial cancer.

  26. Frumovitz M, Plante M, Lee PS, Sandadi S Sr, Lilja JF, Escobar PF, et al. The FILM Trial: a randomized phase III multicenter study assessing near infrared fluorescence in the identification of sentinel lymph nodes (SLN). Gynecol Oncol Elsevier. 2018;149:7.

    Article  Google Scholar 

  27. • Bodurtha Smith AJ, Fader AN, Tanner EJ. Sentinel lymph node assessment in endometrial cancer: a systematic review and meta-analysis. Am J Obstet Gynecol. 2017;216(5):459–476.e10 A large meta-analysis exploring test characteristics of SLN mapping for endometrial cancer.

    Article  PubMed  Google Scholar 

  28. Schwartz GF, Giuliano AE, Veronesi U. Proceedings of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast, April 19-22, 2001, Philadelphia, Pennsylvania. Cancer. 2002;94(10):2542–51.

    Article  PubMed  Google Scholar 

  29. Ballester M, Dubernard G, Lecuru F, Heitz D, Mathevet P, Marret H, et al. Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer: a prospective multicentre study (SENTI-ENDO). Lancet Oncol. 2011;12(5):469–76.

    Article  PubMed  Google Scholar 

  30. Kim CH, Soslow RA, Park KJ, Barber EL, Khoury-Collado F, Barlin JN, et al. Pathologic ultrastaging improves micrometastasis detection in sentinel lymph nodes during endometrial cancer staging. Int J Gynecol Cancer United States. 2013;23(5):964–70.

    Article  Google Scholar 

  31. Raimond E, Ballester M, Hudry D, Bendifallah S, Darai E, Graesslin O, et al. Impact of sentinel lymph node biopsy on the therapeutic management of early-stage endometrial cancer: results of a retrospective multicenter study. Gynecol Oncol. 2014;133(3):506–11.

    Article  PubMed  Google Scholar 

  32. Naoura I, Canlorbe G, Bendifallah S, Ballester M, Darai E. Relevance of sentinel lymph node procedure for patients with high-risk endometrial cancer. Gynecol Oncol. 2015;136(1):60–4.

    Article  PubMed  Google Scholar 

  33. St Clair CM, Eriksson AGZ, Ducie JA, Jewell EL, Alektiar KM, Hensley ML, et al. Low-volume lymph node metastasis discovered during sentinel lymph node mapping for endometrial carcinoma. Ann Surg Oncol. 2016;23(5):1653–9.

    Article  PubMed  Google Scholar 

  34. Backes FJ, Felix AS, Grégoire J, Plante M, Sullivan SA, Rossi EC, et al. Sentinel lymph node (SLN) isolated tumor cells (ITCs) in otherwise stage I/II endometrioid endometrial cancer: to treat or not to treat? Gynecol Oncol Elsevier. 2018;149:7–8.

    Article  Google Scholar 

  35. Plante M, Stanleigh J, Renaud M-C, Sebastianelli A, Grondin K, Gregoire J. Isolated tumor cells identified by sentinel lymph node mapping in endometrial cancer: does adjuvant treatment matter? Gynecol Oncol. 2017;146(2):240–6.

    Article  PubMed  Google Scholar 

  36. Tanner E, Puechl A, Levinson K, Havrilesky LJ, Sinno A, Secord AA, et al. Use of a novel sentinel lymph node mapping algorithm reduces the need for pelvic lymphadenectomy in low-grade endometrial cancer. Gynecol Oncol 2017;

  37. Ducie JA, Eriksson AGZ, Ali N, McGree ME, Weaver AL, Bogani G, et al. Comparison of a sentinel lymph node mapping algorithm and comprehensive lymphadenectomy in the detection of stage IIIC endometrial carcinoma at higher risk for nodal disease. Gynecol Oncol. 2017;147:541–8.

    Article  PubMed  Google Scholar 

  38. •• Rossi EC, Kowalski LD, Scalici J, Cantrell L, Schuler K, Hanna RK, et al. A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): a multicentre, prospective, cohort study. Lancet Oncol. 2017;18(3):384–92 Demonstrated that SLNs detected using ICG are extremely accurate in identifying endometrial cancer metastasis.

    Article  PubMed  Google Scholar 

  39. Soliman PT, Westin SN, Dioun S, Sun CC, Euscher E, Munsell MF, et al. A prospective validation study of sentinel lymph node mapping for high-risk endometrial cancer. Gynecol Oncol. 2017;146:234–9.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Schiavone MB, Scelzo C, Straight C, Zhou Q, Alektiar KM, Makker V, et al. Survival of patients with serous uterine carcinoma undergoing sentinel lymph node mapping. Ann Surg Oncol United States. 2017 Jul;24(7):1965–71.

    Article  Google Scholar 

  41. Schiavone MB, Zivanovic O, Zhou Q, Leitao MMJ, Levine DA, Soslow RA, et al. Survival of patients with uterine carcinosarcoma undergoing sentinel lymph node mapping. Ann Surg Oncol. 2016;23:196–202.

    Article  PubMed  Google Scholar 

  42. 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 

  43. Slama J, Dundr P, Dusek L, Fischerova D, Pinkavova I, Zikan M, et al. Sentinel lymph node status in patients with locally advanced cervical cancers and impact of neoadjuvant chemotherapy. Gynecol Oncol. 2012;125(2):303–6.

    Article  CAS  PubMed  Google Scholar 

  44. Beavis AL, Salazar-Marioni S, Sinno AK, Stone RL, Fader AN, Santillan-Gomez A, et al. Sentinel lymph node detection rates using indocyanine green in women with early-stage cervical cancer. Gynecol Oncol. 2016;143(2):302–6.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Rob L, Robova H, Halaska MJ, Hruda M, Skapa P. Current status of sentinel lymph node mapping in the management of cervical cancer. Expert Rev Anticancer Ther. 2013;13(7):861–70.

    Article  PubMed  Google Scholar 

  46. Altgassen C, Hertel H, Brandstadt A, Kohler C, Durst 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 

  47. Lecuru F, Mathevet P, Querleu D, Leblanc E, Morice P, Darai 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 

  48. Salvo G, Ramirez PT, Levenback CF, Munsell MF, Euscher ED, Soliman PT, et al. Sensitivity and negative predictive value for sentinel lymph node biopsy in women with early-stage cervical cancer. Gynecol Oncol. 2017;145(1):96–101.

    Article  PubMed  PubMed Central  Google Scholar 

  49. • Mathevet P, Lecuru F, Magaud L, Bouttitie F Sentinel lymph node biopsy for early cervical cancer: results of a randomized prospective, multicenter study (Senticol 2) comparing adding pelvic lymph node dissection vs sentinel node biopsy only. Gynecol Oncol. Elsevier; 2017 Jun;145:2–3. Demonstrated accuracy of SLN mapping in predicting lymph node status in cervical cancer

  50. Melamed CL, Keating NL, del Carmen MG, Wright JD, Rauh-Hain JA. Comparative effectiveness of minimally-invasive staging surgery in women with early-stage cervical cancer. Gynecol Oncol. Elsevier. 2018;149:245–6.

    Article  Google Scholar 

  51. Cibula D, Abu-Rustum NR, Dusek L, Zikan M, Zaal A, Sevcik L, 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 

  52. •• Ramirez PT, Frumovitz M, Pareja R, Lopez A, Vieira MA, Ribeiro R. Phase III randomized trial of laparoscopic or robotic versus abdominal radical hysterectomy in patients with early-stage cervical cancer: LACC Trial. Gynecol Oncol. Elsevier. 2018;149:245 Abstract only: demonstrated a threefold increased risk of recurrence and decrease in overall survival for a minimally invasive approach as opposed to an open radical hysterectomy approach for early-stage cervical cancer patients.

    Article  Google Scholar 

  53. Mitra S, Sharma MK, Kaur I, Khurana R, Modi KB, Narang R, et al. Vulvar carcinoma: dilemma, debates, and decisions. Cancer Manag Res. 2018;10:61–8.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Levenback CF, Ali S, Coleman RL, Gold MA, Fowler JM, Judson PL, et al. Lymphatic mapping and sentinel lymph node biopsy in women with squamous cell carcinoma of the vulva: a gynecologic oncology group study. J Clin Oncol. 2012;30:3786–91.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Van der Zee AGJ, Oonk MH, De Hullu JA, Ansink AC, Vergote I, Verheijen RH, et al. Sentinel node dissection is safe in the treatment of early-stage vulvar cancer. J Clin Oncol 2008;

  56. Oonk MHM. New diagnostic and therapeutic options in early-stage vulvar cancer. Groningen; 2011.

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Authors and Affiliations

  1. The Kelly Gynecologic Oncology Service, Johns Hopkins Hospital, 600 N Wolfe St. Phipps 281, Baltimore, MD, 21287, USA

    C. Reneé Franklin & Edward J. Tanner III

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  1. C. Reneé Franklin
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  2. Edward J. Tanner III
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Correspondence to Edward J. Tanner III.

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C. Reneé Franklin and Edward J. Tanner III declare they have no conflict of interest.

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This article is part of the Topical Collection on Gynecologic Cancers

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Reneé Franklin, C., Tanner, E.J. Where Are We Going with Sentinel Lymph Node Mapping in Gynecologic Cancers?. Curr Oncol Rep 20, 96 (2018). https://doi.org/10.1007/s11912-018-0744-4

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