Sentinel lymph node in cervical cancer: time to move forward.

Area of Science:

• Gynecologic Oncology
• Surgical Oncology
• Cancer Staging

Background:

• Lymph node status is critical for therapeutic decisions and survival in early-stage cervical cancer.
• Current guidelines recommend pelvic lymphadenectomy, but sentinel lymph node (SLN) biopsy is emerging as a less morbid alternative.
• SLN biopsy techniques, including those using indocyanine green (ICG), are evolving to improve detection accuracy.

Purpose of the Study:

• To evaluate the role and accuracy of sentinel lymph node (SLN) biopsy in staging early-stage cervical cancer.
• To compare SLN biopsy with traditional pelvic lymph node dissection (PLND) regarding diagnostic value and patient morbidity.
• To highlight areas of ongoing debate and future research directions in SLN biopsy for cervical cancer.

Main Methods:

• Review of current literature and guidelines on lymph node staging in cervical cancer.
• Discussion of SLN biopsy techniques, including combined technetium-99/blue dye and indocyanine green (ICG) methods.
• Analysis of the diagnostic yield of SLN biopsy, including ultrastaging for micrometastases and isolated tumor cells (ITCs).

Main Results:

• SLN biopsy offers accurate anatomical staging and improved detection of low-volume nodal metastases compared to PLND.
• The technique, when performed with appropriate patient selection and training, can achieve high detection rates and sensitivity.
• Reduced morbidity, particularly lower-limb lymphoedema, is a significant advantage of SLN biopsy over PLND.

Conclusions:

• SLN biopsy is a feasible and accurate alternative for lymph node staging in early-stage cervical cancer, reducing associated morbidity.
• Further prospective evidence is required to establish SLN biopsy as the gold standard, particularly concerning intraoperative assessment accuracy and the oncological impact of micrometastases.
• Ongoing trials (SENTIX, PHENIX, SENTICOL III) are expected to provide crucial data on the long-term safety and efficacy of SLN biopsy.