The role of sentinel node biopsy in gynecological cancer: a review.
OBJECTIVE
In early-stage vulvar, cervical and endometrial cancer, lymph node status is the most important prognostic factor. Surgical treatment is aimed at removing the primary tumor and adequately staging the regional lymph nodes. As morbidity of regional lymphadenectomy is high, sentinel node biopsy is a technique with potential for adequate staging with less treatment-related morbidity. This manuscript reviews its current role in vulvar, cervical and endometrial cancer.


RESULTS
In early-stage vulvar cancer, level 3 evidence indicates that it appears to be safe to omit inguinofemoral lymphadenectomy in case of a negative sentinel node. However, false-negative results with fatal consequences do occur and are often attributable to procedural failures. For early-stage cervical cancer, level 3 evidence points to an acceptable false-negative rate of a negative sentinel node; clinical utility and safety remain to be established. The optimal technique of the sentinel node biopsy in endometrial cancer is currently unclear.


CONCLUSIONS
In early-stage vulvar cancer, data suggest that sentinel node biopsy could be offered as a treatment option instead of routine inguinofemoral lymphadenectomy. However, more (long-term follow-up) data are needed to further appreciate real clinical benefits. It is emphasized that the procedure should be performed by a skilled multidisciplinary team, centralized in oncology centers and preferably within the protection of clinical trials. For cervical cancer, data are promising, but routine application cannot be recommended due to lack of data on clinical utility and safety. For endometrial cancer, studies on the sentinel node biopsy are still in feasibility stage.
Oonk
Maaike H M
MH
Department of Gynaecologic Oncology, University Medical Centre Groningen, Groningen, The Netherlands.
van de Nieuwenhof
Hedwig P
HP
de Hullu
Joanne A
JA
van der Zee
Ate G J
AG
D016889:Endometrial Neoplasms / Q000473:pathology; D005260:Female; D005833:Genital Neoplasms, Female / Q000473:pathology*; D006801:Humans; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D009367:Neoplasm Staging; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D002583:Uterine Cervical Neoplasms / Q000473:pathology; D014846:Vulvar Neoplasms / Q000473:pathology