Abstract
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.
Summary
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.
