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Minimally Invasive Gynecology pp 345–359Cite as

Sentinel Node in Gynecological Cancer

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Abstract

The sentinel node technique is increasingly used in vulvar, cervical, and endometrial cancer. There is evidence that injecting the cervix or early unifocal vulvar tumors with the appropriate tracer—patent blue, isocyanine blue, technetium-99m-containing colloid, or indocyanine green—allows the visualization of the lymph channels and the identification of the sentinel node. Only bilateral identification provides relevant oncological information, hence the need to perform a full ipsilateral node dissection when the sentinel node is not identified in one or two pelvic sidewalls. In the same way, bilateral identification is mandatory in case of vulvar cancer involving the midline.

Comprehensive assessment of the sentinel nodes including serial sections and immunohistochemistry is the best known technique to identify low-volume metastatic disease. As a consequence, the sentinel lymph node technique complements full pelvic or inguinal dissection when indicated, by selecting the nodes most at risk and most likely to display small amounts of malignant cells which cannot be found on standard pathological examination of all nodes of a given area.

The evolution toward removing only the sentinel node when negative has been found to be safe in vulvar cancers. In cervical cancers, there is evidence that a negative sentinel node rules out metastatic disease in the other nodes. In endometrial cancer, sentinel node only is an attractive compromise wherever the risk of node involvement is minimal but not zero.

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  1. Hospital Pilar Quiron Salud, Barcelona, Spain

    Cecilia Escayola Vilanova M.D.

  2. Department of Surgery, Institut Bergonié, Bordeaux, France

    Denis Querleu M.D.

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    Geraldo Gastal Gomes-da-Silveira

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  3. Universidade Federal do Rio Grande do Sul (UFRGS) and Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil

    Suzana Arenhart Pessini

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Vilanova, C.E., Querleu, D. (2018). Sentinel Node in Gynecological Cancer. In: Gomes-da-Silveira, G.G., da Silveira, G.P.G., Pessini, S.A. (eds) Minimally Invasive Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-319-72592-5_31

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