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Current Oncology Reports

, 20:96 | Cite as

Where Are We Going with Sentinel Lymph Node Mapping in Gynecologic Cancers?

  • C. Reneé Franklin
  • Edward J. TannerIIIEmail author
Gynecologic Cancers (NS Reed, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Gynecologic Cancers

Abstract

Purpose of Review

Sentinel lymph node (SLN) mapping is a standard of care for lymphatic assessment of many early-stage gynecologic malignancies. We review the current data, emphasizing the utility of SLN mapping in the management of gynecologic cancers.

Recent Findings

Endometrial cancer: recent studies have focused on confirming the safety and efficacy of SLN mapping for high-risk patients. Cervical cancer: the LACC Trial demonstrated reduced survival with minimally invasive surgery, calling into question the validity of prior studies evaluating SLN mapping with a minimally invasive approach. Vulvar cancer: the ongoing GROINS-V-II trial is investigating whether patients with SLN metastasis < 2 mm in diameter can safely undergo adjuvant radiation ± chemotherapy without completion inguinal lymphadenectomy.

Summary

NCCN guidelines have incorporated SLN mapping as a lymphatic assessment strategy for endometrial, cervical, and vulvar malignancies. SLN mapping appears to reduce morbidity while still maintaining an appropriate detection rate of lymphatic metastasis. Additional clinical trials will further our knowledge of these procedures.

Keywords

Sentinel lymph node Sentinel lymph node mapping Endometrial cancer Vulvar cancer Cervical cancer Lymphadenectomy Lymphedema Ultrastaging 

Notes

Compliance with Ethical Standards

Conflict of Interest

C. Reneé Franklin and Edward J. Tanner III declare they have 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.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Cabanas RM. An approach for the treatment of penile carcinoma. Cancer. 1977;39(2):456–66.PubMedCrossRefGoogle Scholar
  2. 2.
    Mocellin S, Hoon DSB, Pilati P, Rossi CR, Nitti D. Sentinel lymph node molecular ultrastaging in patients with melanoma: a systematic review and meta-analysis of prognosis. J Clin Oncol. 2007;25(12):1588–95.PubMedCrossRefGoogle Scholar
  3. 3.
    Cody HS 3rd. Sentinel lymph node mapping in breast cancer. Breast Cancer. 1999;6(1):13–22.PubMedCrossRefGoogle Scholar
  4. 4.
    Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127(4):392–9.PubMedCrossRefGoogle Scholar
  5. 5.
    National Comprehensive Cancer Network. Vulvar cancer (Version 1.2019). 2018. Available from: https://www.nccn.org/professionals/physician_gls/pdf/vulvar.pdf
  6. 6.
    National Comprehensive Cancer Network. Cervical cancer (Version 1.2019). 2018. Available from: https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf
  7. 7.
    National Comprehensive Cancer Network. Uterine neoplasms (Version 2.2018). 2018. Available from: https://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf
  8. 8.
    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017;67(1):7–30.CrossRefGoogle Scholar
  9. 9.
    Abu-Rustum NR. Sentinel lymph node mapping for endometrial cancer: a modern approach to surgical staging. J Natl Compr Cancer Netw. 2014;12(2):288–97.CrossRefGoogle Scholar
  10. 10.
    Kitchener H, Swart AMC, Qian Q, Amos C, Parmar MKB. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet (London, England). 2009;373(9658):125–36.CrossRefGoogle Scholar
  11. 11.
    Yost KJ, Cheville AL, Al-Hilli MM, Mariani A, Barrette BA, McGree ME, et al. Lymphedema after surgery for endometrial cancer: prevalence, risk factors, and quality of life. Obstet Gynecol. 2014;124(2 Pt 1):307–15.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Todo Y, Yamamoto R, Minobe S, Suzuki Y, Takeshi U, Nakatani M, et al. Risk factors for postoperative lower-extremity lymphedema in endometrial cancer survivors who had treatment including lymphadenectomy. Gynecol Oncol. 2010;119(1):60–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, Scambia G, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008;100(23):1707–16.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Case AS, Rocconi RP, Straughn JMJ, Conner M, Novak L, Wang W, et al. A prospective blinded evaluation of the accuracy of frozen section for the surgical management of endometrial cancer. Obstet Gynecol United States. 2006;108(6):1375–9.CrossRefGoogle Scholar
  15. 15.
    Kumar S, Bandyopadhyay S, Semaan A, Shah JP, Mahdi H, Morris R, et al. The role of frozen section in surgical staging of low risk endometrial cancer. PLoS One. 2011;6:e21912.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Mariani A, Dowdy SC, Cliby WA, Gostout BS, Jones MB, Wilson TO, et al. Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol. 2008;109:11–8.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Barlin JN, Khoury-Collado F, Kim CH, Leitao MM, Chi DS, Sonoda Y, et al. The importance of applying a sentinel lymph node mapping algorithm in endometrial cancer staging: beyond removal of blue nodes. Gynecol Oncol. 2012;125(3):531–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Sinno AK, Fader AN, Tanner EJ. Single site robotic sentinel lymph node biopsy and hysterectomy in endometrial cancer. Gynecol Oncol 2015;137(1).Google Scholar
  19. 19.
    Sinno AK, Fader AN, Roche KL, Giuntoli II RL, Tanner EJ. A comparison of colorimetric versus fluorometric sentinel lymph node mapping during robotic surgery for endometrial cancer. Gynecol Oncol 2014;134(2).Google Scholar
  20. 20.
    Torne A, Pahisa J, Vidal-Sicart S, Martinez-Roman S, Paredes P, Puerto B, et al. Transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR): a new method for sentinel lymph node detection in endometrial cancer. Gynecol Oncol. 2013;128(1):88–94.PubMedCrossRefGoogle Scholar
  21. 21.
    Solima E, Martinelli F, Ditto A, Maccauro M, Carcangiu M, Mariani L, et al. Diagnostic accuracy of sentinel node in endometrial cancer by using hysteroscopic injection of radiolabeled tracer. Gynecol Oncol. 2012;126(3):419–23.PubMedCrossRefGoogle Scholar
  22. 22.
    Kang S, Yoo HJ, Hwang JH, Lim M-C, Seo S-S, Park S-Y. Sentinel lymph node biopsy in endometrial cancer: meta-analysis of 26 studies. Gynecol Oncol. 2011;123(3):522–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Khoury-Collado F, Abu-Rustum NR. Lymphatic mapping in endometrial cancer: a literature review of current techniques and results. Int J Gynecol Cancer. 2008;18(6):1163–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Abu-Rustum NR, Khoury-Collado F, Gemignani ML. Techniques of sentinel lymph node identification for early-stage cervical and uterine cancer. Gynecol Oncol. 2008;111(2 Suppl):S44–50.PubMedCrossRefGoogle Scholar
  25. 25.
    • Holloway RW, Abu-Rustum NR, Backes FJ, Boggess JF, Gotlieb WH, Jeffrey Lowery W, et al. Sentinel lymph node mapping and staging in endometrial cancer: a Society of Gynecologic Oncology literature review with consensus recommendations. Gynecol Oncol. 2017; Consensus statement from the SGO evaluating current controversies in SLN mapping for endometrial cancer.Google Scholar
  26. 26.
    Frumovitz M, Plante M, Lee PS, Sandadi S Sr, Lilja JF, Escobar PF, et al. The FILM Trial: a randomized phase III multicenter study assessing near infrared fluorescence in the identification of sentinel lymph nodes (SLN). Gynecol Oncol Elsevier. 2018;149:7.CrossRefGoogle Scholar
  27. 27.
    • Bodurtha Smith AJ, Fader AN, Tanner EJ. Sentinel lymph node assessment in endometrial cancer: a systematic review and meta-analysis. Am J Obstet Gynecol. 2017;216(5):459–476.e10 A large meta-analysis exploring test characteristics of SLN mapping for endometrial cancer.PubMedCrossRefGoogle Scholar
  28. 28.
    Schwartz GF, Giuliano AE, Veronesi U. Proceedings of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast, April 19-22, 2001, Philadelphia, Pennsylvania. Cancer. 2002;94(10):2542–51.PubMedCrossRefGoogle Scholar
  29. 29.
    Ballester M, Dubernard G, Lecuru F, Heitz D, Mathevet P, Marret H, et al. Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer: a prospective multicentre study (SENTI-ENDO). Lancet Oncol. 2011;12(5):469–76.PubMedCrossRefGoogle Scholar
  30. 30.
    Kim CH, Soslow RA, Park KJ, Barber EL, Khoury-Collado F, Barlin JN, et al. Pathologic ultrastaging improves micrometastasis detection in sentinel lymph nodes during endometrial cancer staging. Int J Gynecol Cancer United States. 2013;23(5):964–70.CrossRefGoogle Scholar
  31. 31.
    Raimond E, Ballester M, Hudry D, Bendifallah S, Darai E, Graesslin O, et al. Impact of sentinel lymph node biopsy on the therapeutic management of early-stage endometrial cancer: results of a retrospective multicenter study. Gynecol Oncol. 2014;133(3):506–11.PubMedCrossRefGoogle Scholar
  32. 32.
    Naoura I, Canlorbe G, Bendifallah S, Ballester M, Darai E. Relevance of sentinel lymph node procedure for patients with high-risk endometrial cancer. Gynecol Oncol. 2015;136(1):60–4.PubMedCrossRefGoogle Scholar
  33. 33.
    St Clair CM, Eriksson AGZ, Ducie JA, Jewell EL, Alektiar KM, Hensley ML, et al. Low-volume lymph node metastasis discovered during sentinel lymph node mapping for endometrial carcinoma. Ann Surg Oncol. 2016;23(5):1653–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Backes FJ, Felix AS, Grégoire J, Plante M, Sullivan SA, Rossi EC, et al. Sentinel lymph node (SLN) isolated tumor cells (ITCs) in otherwise stage I/II endometrioid endometrial cancer: to treat or not to treat? Gynecol Oncol Elsevier. 2018;149:7–8.CrossRefGoogle Scholar
  35. 35.
    Plante M, Stanleigh J, Renaud M-C, Sebastianelli A, Grondin K, Gregoire J. Isolated tumor cells identified by sentinel lymph node mapping in endometrial cancer: does adjuvant treatment matter? Gynecol Oncol. 2017;146(2):240–6.PubMedCrossRefGoogle Scholar
  36. 36.
    Tanner E, Puechl A, Levinson K, Havrilesky LJ, Sinno A, Secord AA, et al. Use of a novel sentinel lymph node mapping algorithm reduces the need for pelvic lymphadenectomy in low-grade endometrial cancer. Gynecol Oncol 2017;Google Scholar
  37. 37.
    Ducie JA, Eriksson AGZ, Ali N, McGree ME, Weaver AL, Bogani G, et al. Comparison of a sentinel lymph node mapping algorithm and comprehensive lymphadenectomy in the detection of stage IIIC endometrial carcinoma at higher risk for nodal disease. Gynecol Oncol. 2017;147:541–8.PubMedCrossRefGoogle Scholar
  38. 38.
    •• Rossi EC, Kowalski LD, Scalici J, Cantrell L, Schuler K, Hanna RK, et al. A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): a multicentre, prospective, cohort study. Lancet Oncol. 2017;18(3):384–92 Demonstrated that SLNs detected using ICG are extremely accurate in identifying endometrial cancer metastasis.PubMedCrossRefGoogle Scholar
  39. 39.
    Soliman PT, Westin SN, Dioun S, Sun CC, Euscher E, Munsell MF, et al. A prospective validation study of sentinel lymph node mapping for high-risk endometrial cancer. Gynecol Oncol. 2017;146:234–9.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Schiavone MB, Scelzo C, Straight C, Zhou Q, Alektiar KM, Makker V, et al. Survival of patients with serous uterine carcinoma undergoing sentinel lymph node mapping. Ann Surg Oncol United States. 2017 Jul;24(7):1965–71.CrossRefGoogle Scholar
  41. 41.
    Schiavone MB, Zivanovic O, Zhou Q, Leitao MMJ, Levine DA, Soslow RA, et al. Survival of patients with uterine carcinosarcoma undergoing sentinel lymph node mapping. Ann Surg Oncol. 2016;23:196–202.PubMedCrossRefGoogle Scholar
  42. 42.
    Rob L, Strnad P, Robova H, Charvat M, Pluta M, Schlegerova D, et al. Study of lymphatic mapping and sentinel node identification in early stage cervical cancer. Gynecol Oncol. 2005;98(2):281–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Slama J, Dundr P, Dusek L, Fischerova D, Pinkavova I, Zikan M, et al. Sentinel lymph node status in patients with locally advanced cervical cancers and impact of neoadjuvant chemotherapy. Gynecol Oncol. 2012;125(2):303–6.PubMedCrossRefGoogle Scholar
  44. 44.
    Beavis AL, Salazar-Marioni S, Sinno AK, Stone RL, Fader AN, Santillan-Gomez A, et al. Sentinel lymph node detection rates using indocyanine green in women with early-stage cervical cancer. Gynecol Oncol. 2016;143(2):302–6.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Rob L, Robova H, Halaska MJ, Hruda M, Skapa P. Current status of sentinel lymph node mapping in the management of cervical cancer. Expert Rev Anticancer Ther. 2013;13(7):861–70.PubMedCrossRefGoogle Scholar
  46. 46.
    Altgassen C, Hertel H, Brandstadt A, Kohler C, Durst M, Schneider A. Multicenter validation study of the sentinel lymph node concept in cervical cancer: AGO study group. J Clin Oncol. 2008;26(18):2943–51.PubMedCrossRefGoogle Scholar
  47. 47.
    Lecuru F, Mathevet P, Querleu D, Leblanc E, Morice P, Darai E, et al. Bilateral negative sentinel nodes accurately predict absence of lymph node metastasis in early cervical cancer: results of the SENTICOL study. J Clin Oncol. 2011;29(13):1686–91.PubMedCrossRefGoogle Scholar
  48. 48.
    Salvo G, Ramirez PT, Levenback CF, Munsell MF, Euscher ED, Soliman PT, et al. Sensitivity and negative predictive value for sentinel lymph node biopsy in women with early-stage cervical cancer. Gynecol Oncol. 2017;145(1):96–101.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    • Mathevet P, Lecuru F, Magaud L, Bouttitie F Sentinel lymph node biopsy for early cervical cancer: results of a randomized prospective, multicenter study (Senticol 2) comparing adding pelvic lymph node dissection vs sentinel node biopsy only. Gynecol Oncol. Elsevier; 2017 Jun;145:2–3. Demonstrated accuracy of SLN mapping in predicting lymph node status in cervical cancer Google Scholar
  50. 50.
    Melamed CL, Keating NL, del Carmen MG, Wright JD, Rauh-Hain JA. Comparative effectiveness of minimally-invasive staging surgery in women with early-stage cervical cancer. Gynecol Oncol. Elsevier. 2018;149:245–6.CrossRefGoogle Scholar
  51. 51.
    Cibula D, Abu-Rustum NR, Dusek L, Zikan M, Zaal A, Sevcik L, et al. Prognostic significance of low volume sentinel lymph node disease in early-stage cervical cancer. Gynecol Oncol. 2012;124(3):496–501.PubMedCrossRefGoogle Scholar
  52. 52.
    •• Ramirez PT, Frumovitz M, Pareja R, Lopez A, Vieira MA, Ribeiro R. Phase III randomized trial of laparoscopic or robotic versus abdominal radical hysterectomy in patients with early-stage cervical cancer: LACC Trial. Gynecol Oncol. Elsevier. 2018;149:245 Abstract only: demonstrated a threefold increased risk of recurrence and decrease in overall survival for a minimally invasive approach as opposed to an open radical hysterectomy approach for early-stage cervical cancer patients.CrossRefGoogle Scholar
  53. 53.
    Mitra S, Sharma MK, Kaur I, Khurana R, Modi KB, Narang R, et al. Vulvar carcinoma: dilemma, debates, and decisions. Cancer Manag Res. 2018;10:61–8.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 54.
    Levenback CF, Ali S, Coleman RL, Gold MA, Fowler JM, Judson PL, et al. Lymphatic mapping and sentinel lymph node biopsy in women with squamous cell carcinoma of the vulva: a gynecologic oncology group study. J Clin Oncol. 2012;30:3786–91.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Van der Zee AGJ, Oonk MH, De Hullu JA, Ansink AC, Vergote I, Verheijen RH, et al. Sentinel node dissection is safe in the treatment of early-stage vulvar cancer. J Clin Oncol 2008;Google Scholar
  56. 56.
    Oonk MHM. New diagnostic and therapeutic options in early-stage vulvar cancer. Groningen; 2011.Google Scholar

Copyright information

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

Authors and Affiliations

  1. 1.The Kelly Gynecologic Oncology ServiceJohns Hopkins HospitalBaltimoreUSA

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