ASGO 2016 ASM Sentinel Lymph Node Mapping for Cervical Cancer (3119)
Lymphadenectomy, in some form, for early stage cervical cancer is a widely accepted standard. Its role is predominantly diagnostic, particularly in determining which patients might benefit from chemotherapy and radiation, and potentially in identifying when to omit or abort hysterectomy. Preoperative imaging, for exampled with PET/CT, has not proven to be an adequately reliable (or accessible) tool. Sentinel lymph node (SLN) mapping for cervical cancer has emerged over the past two decades and a potential alternative, and in some countries is considered a standard approach. In general, however, the technique has been explored with smaller series and definitive accuracy studies are lacking.
In this lecture we will explore the available data with focus on larger, multi-institutional series such as SENTICOL and FIRES. We will explore the optimal patients for whom this technique can be considered, such as patients with <2cm tumors and the choices in tracer that are available. Should we consider conization with SLN biopsy as the ultimate in minimally invasive surgery for microinvasive cervical cancer? We will discuss the role, and limitations, of intraoperative frozen section for decision-making. The previously presented results from SENTICOL-2 will be discussed, including the morbidity data that demonstrates a reduction in lymphedema when SLN biopsy is employed. Finally we will discuss some of the challenges with interpreting the SLN biopsy results including micro metastatic volume and whether completion lymphadenectomy should follow positive results.
