Updates in Sentinel Lymph Node Mapping in Gynecologic Cancer

  • Abdulrahman K. SinnoEmail author
  • Sanskriti Varma
  • Edward J. TannerIII
Gynecologic Oncology (A Fader, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Gynecologic Oncology


Purpose of Review

The aim of this study is to review the indications, techniques, and outcomes of sentinel lymph node (SLN) mapping in endometrial, cervical, and vulvar cancers.

Recent Findings

In endometrial cancer, the prospective FIRES trial showed that the negative predictive value of SLN mapping was 99.6%. Furthermore, multi-institutional retrospective studies comparing SLN mapping to traditional lymphadenectomy have found comparable survival between the two techniques, in both type 1 and type 2 endometrial cancer. In cervical cancer, randomized data from the SENTICOL-2 study has demonstrated significant reduction in postoperative complications without compromising survival with SLN mapping as compared to SLN mapping and pelvic lymphadenectomy. In vulvar cancer, the GROINS-V-II study protocol was amended to mandate inguinofemoral lymphadenectomy in all patients with SLN macrometastasis greater than 2 mm after unacceptably high rates of groin recurrences were observed on interim analysis. SLN mapping is now included in the treatment guidelines of the National Comprehensive Cancer Network guidelines for endometrial, cervical, and vulvar cancer as an acceptable lymphatic assessment technique in select patients.


SLN biopsy is a safe and effective alternative to systematic lymphadenectomy for women with early-stage endometrial, cervical, and vulvar cancer. Recent data has validated the excellent sensitivity and negative predictive value of this technique in carefully selected patients, without compromising survival. The use of an algorithm that mandates pathologic ultrastaging on all SLNs, and ipsilateral lymphadenectomy in cases of failed bilateral mapping improves sensitivity and negative predictive value. All suspicious lymph nodes should be resected regardless of the location of the SLN. In patients with vulvar cancer, SLN biopsy is an acceptable standard of care for patients with unifocal tumors, less than 4 cm in largest diameter, and clinically and radiographically negative groin nodes.


Sentinel lymph node Cervical cancer Endometrial cancer Vulvar cancer Fluorescence imaging Lymphedema 


Compliance with Ethical Standards

Conflict of Interest

Abdulrahman K. Sinno, Sanskriti Varma, and Edward J. Tanner III declare 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

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Abdulrahman K. Sinno
    • 1
    Email author
  • Sanskriti Varma
    • 2
  • Edward J. TannerIII
    • 2
  1. 1.Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLAOlive View-UCLA Medical CenterLos AngelesUSA
  2. 2.The Kelly Gynecologic Oncology Service, Department of Gynecology and ObstetricsJohns Hopkins HospitalBaltimoreUSA

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