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Gynecologic Oncology

Sentinel Lymph Node Biopsy in the Management of Vulvar Carcinoma, Cervical Cancer, and Endometrial Cancer

Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

Key Words. Sentinel lymph node biopsy • SLN biopsy • Vulvar carcinoma • Cervical cancer • Endometrial cancer • Staging procedures • Regional lymphadenectomy

Correspondence: Mary L. Gemignani, M.D., M.P.H., Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USA. Telephone: 212-639-8125; Fax: 212-717-3214; e-mail: gynbreast{at}mskcc.org

Received April 10, 2009; accepted for publication May 22, 2009; first published online in THE ONCOLOGIST Express on July 16, 2009.

Disclosures: Oliver Zivanovic: None; Fady Khoury-Collado: None; Nadeem R. Abu-Rustum: None; Mary L. Gemignani: None.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors or independent peer reviewers.

The treatment of gynecologic malignancies can include surgery, systemic therapy, and radiation. Depending on the primary site of disease and the extent of the disease, these treatment strategies are applied alone or in combination.

Trends over the past few decades have concentrated on performing more comprehensive staging procedures for a large percentage of patients with gynecologic malignancies. The surgical techniques available for comprehensive staging have facilitated a greater understanding of stage and prognosis overall, and better tailoring of postsurgical treatment.

One such technique is regional lymphadenectomy. Although the role of regional lymphadenectomy as a therapeutic procedure in some gynecologic cancers is debated and challenged (regional lymphadenectomy and multimodality therapy increases adverse side effects and long-term sequelae without proven survival benefit), there is no controversy regarding the staging and prognostic benefit of the evaluation of regional lymph nodes. The sentinel lymph node (SLN) concept was successfully introduced in melanoma. It has since become the standard of care in breast cancer and has had a significant impact on postoperative morbidity for a large percentage of breast cancer patients. Interest in using SLN techniques in gynecologic cancers was thus a natural progression. In light of the growing body of evidence in the literature opposing the therapeutic benefit of systematic lymphadenectomy, the SLN concept will continue to play an important role in the treatment of gynecologic malignancies. This technique can provide accurate staging information in some gynecologic cancers. Increased use of this technique could potentially impact the quality of life of gynecologic cancer survivors while still providing important staging information without compromising oncologic safety.

In this review, we examine the body of literature related to gynecologic cancer malignancies and SLN biopsy.