Where Are We Going with Sentinel Lymph Node Mapping in Gynecologic Cancers?
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.
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.
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.
KeywordsSentinel lymph node Sentinel lymph node mapping Endometrial cancer Vulvar cancer Cervical cancer Lymphadenectomy Lymphedema Ultrastaging
Compliance with Ethical Standards
Conflict of Interest
C. Reneé Franklin and Edward J. Tanner III declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 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
- 18.Sinno AK, Fader AN, Tanner EJ. Single site robotic sentinel lymph node biopsy and hysterectomy in endometrial cancer. Gynecol Oncol 2015;137(1).Google Scholar
- 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).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.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;Google Scholar
- 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.PubMedCrossRefGoogle 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.PubMedCrossRefGoogle 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 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.CrossRefGoogle 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;Google Scholar
- 56.Oonk MHM. New diagnostic and therapeutic options in early-stage vulvar cancer. Groningen; 2011.Google Scholar