Sentinel node navigation surgery in cervical cancer: a systematic review and metaanalysis

Area of Science:

• Gynecologic Oncology
• Surgical Pathology
• Nuclear Medicine Imaging

Background:

• Sentinel lymph node navigation surgery (SNNS) is a clinical approach for cervical cancer treatment.
• Assessing optimal SLN mapping and SNNS safety is crucial for patient outcomes.

Purpose of the Study:

• To determine the best sentinel lymph node (SLN) mapping technique for cervical cancer.
• To evaluate the safety and benefits of SNNS in cervical cancer patients.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) and studies on SLN biopsy (SLNB) in cervical cancer (Jan 2012-Dec 2020).
• Data extraction and quality assessment by two independent authors.
• Quantitative analysis of SLN detection rates, tracer sensitivity/specificity, and complications; review of survival data for SNNS without pelvic lymphadenectomy (PLND).

Main Results:

• SLN mapping detection rates were high: unilateral pelvis median 95.7%-100% (Tc w/wo BD) and 80.4%-90% (ICG); bilateral pelvis median 80.4%-90% (Tc w/wo BD) and 95.7%-100% (ICG).
• All tracers (Tc w/wo BD, BD w/wo Tc, ICG, carbon nanoparticle) demonstrated high sensitivity and specificity (AUCs 0.931-0.988).
• SNNS without systematic PLND showed no adverse impact on recurrence or survival in early-stage cervical cancer (tumor size ≤ 2-4 cm), while reducing morbidities like lymphedema and neurological symptoms associated with PLND.

Conclusions:

• Both Technetium-99m (Tc) with/without blue dye (BD) and indocyanine green (ICG) are suitable tracers for SLN mapping in cervical cancer.
• SNNS offers a safer alternative to systematic pelvic lymphadenectomy (PLND), reducing morbidity without compromising oncological outcomes in early-stage disease.