Sentinel node in gynecological cancers

Abstract

Sentinel node biopsy (SNB) is a minimally invasive technique for assessing the nodal involvement in some gynecological cancers. This technique is safe and feasible in early stages of cervical and vulvar cancers, while is still matter of controversy in early endometrial, vaginal and ovarian cancers. It is indicated for squamous cell carcinoma of vulva with T<4cm, >1mm depth of invasion and cN0. In cervical cancer, it is advised in stages IA1 with lymphovascular invasion to IB2. In endometrial cancer, it may be considered in patients with apparent uterine-confined disease and cN0 or no obvious extra-uterine disease at exploration or even in high-risk histologies. Preoperative lymphoscintigraphy and SPECT/CT images are crucial to mapping the lymphatic drainage of gynecologic cancers for planning a tailored surgery. Indocyanine green-99mTc-nanocolloid has been recently used in vulvar and cervical cancers with good results, but remains to be confirmed in further studies. Intraoperatively, the handheld gamma probe may be supplemented with the use of a portable gamma camera or an intraoperative freehand SPECT. The ultra-staging should be performed in negative sentinel nodes at hematoxylin and eosin analysis for detecting micro-metastatic disease. Finally, SNB should be done in institutions with expertise in this procedure.