Lymphatic mapping and sentinel lymph node detection in women with cervical cancer

Lymphatic mapping and sentinel node detection have been applied to almost every solid tumor and sentinel node status have become part of the American Joint Commission on Cancer (AJCC) staging criteria in both breast cancer and malignant melanoma. As the presence of metastatic disease in lymph nodes is the most important prognostic factor on survival in women with cervical cancer, the ability to reliably detect sentinel nodes might triage women to adjuvant radiotherapy without the need for full lymphadenectomies and their associated morbidity. To date, multiple international investigators have performed single institution investigations with promising results. Overall, 831 women have been undergoing lymphatic mapping and sentinel node detection as part of their cervical cancer therapy as reported in the literature. Combining results from all these studies, a sentinel node was identified in 90% of cases with an overall sensitivity of detecting metastatic disease of 92% with an 8% false negative rate. The overall negative predictive value was over 97%. There remain controversies in moving forward with accepting sentinel node biopsy as the standard in treating women cervical cancer including 1) determining an acceptable false-negative rate, 2) establishing the importance of micrometastatic disease or isolated tumor cells in sentinel nodes, and 3) discovering the minimum number of cases a surgeon needs to become proficient in mapping techniques. Large, multi-institutional studies in both Europe and the United States are nearing completion and their results should help guide the future direction for sentinel node technologies in the treatment of cervical cancer.