Sentinel lymph node concept in early stages cervical cancer

Objective: Summary of current evidence about sentinel lymph node concept in early stages cervical cancer. Design: Review. Setting: Department of Obstetrics and Gynaecology, General University Hospital, First Faculty of Medicine, Charles University, Prague. Methods: First, a comprehensive search of a peer-reviewed journals in gynaecological oncology was conducted based on a wide range of key words used in PubMed database. Second, the reference section for each article found was searched in order to find additional articles. Third, extensive personal clinical and scientifical experience with sentinel lymph node concept in cervical cancer was utilized. Results: Sentinel lymph node biopsy is routinely used in the management of early stages cervical cancer with high detection rate in skilled surgeon's hands. It has high sensitivity and low false negative rate. The intraoperative sentinel lymph node examination (i.e. frozen section) has low accuracy because it fails to detect about half of cases with lymph node involvement. Final pathological examination with intensive protocol for ultrastaging detects additional 10% of patients with small metastases (i.e. micrometastasis), who would be otherwise missed. There are limited data about the importance of micrometastasis involvement in sentinel lymph node; there is also growing evidence about negative prognostic impact and patients with micrometastasis should be managed with the same criteria as patients with macrometastasis. Conclusion: Sentinel lymph node biopsy followed by full pelvic lymph node dissection is currently standard of care until ongoing prospective trials answer question about oncological safety of less radical surgical approach with sentinel lymph node biopsy only.