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The sentinel node approach in gynaecological malignancies

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ABSTRACT

This review discusses the state-of-the-art of sentinel lymph node mapping in gynaecological malignancies, including cervical cancer, endometrial cancer, and vulvar cancer, with an emphasis on new technological advances. For this objective, PubMed/MEDLINE was searched for relevant studies about the sentinel lymph node procedure in gynaecology. In particular, the use of preoperative lymphatic mapping with lymphoscintigraphy and single photon emission tomography/computed tomography (SPECT/CT) was identified in 18 studies. Other recent advances as hybrid tracers (e.g. ICG-99mTc-nanocolloid) and intraoperative tools (portable γ-camera and 3D navigation devices) appear to also represent a useful guide for the surgeon during the operation. Concerning vulvar and cervical cancers, the sentinel lymph node procedure has been incorporated to the current guidelines in Europe and North America, whereas for endometrial cancer it is considered investigative.

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Anatomical sentinel lymph-node (SLN) distribution in gynaecological malignancies. In vulvar cancer (Ref. [48]), SLNs are limited to the groin and are predominantly found in the superior, central, and medial inferior inguinal Daseler’s zones (a). By contrast, in cervical cancer. (b) SLNs are mainly located along the iliac vessels (Ref. [15]), whereas in endometrial cancer (c) also para-aortic drainage is frequently observed (Ref. [17])
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Fig1: Anatomical sentinel lymph-node (SLN) distribution in gynaecological malignancies. In vulvar cancer (Ref. [48]), SLNs are limited to the groin and are predominantly found in the superior, central, and medial inferior inguinal Daseler’s zones (a). By contrast, in cervical cancer. (b) SLNs are mainly located along the iliac vessels (Ref. [15]), whereas in endometrial cancer (c) also para-aortic drainage is frequently observed (Ref. [17])

Mentions: In gynaecological tumours, the sentinel lymph node (SLN) procedure is principally performed in vulvar cancer (VC), cervical cancer (CC), and endometrial cancer (EC). Although both preoperative lymphatic mapping and intraoperative SLN detection are common parts of SLN procedure in gynaecological tumours, the type of injection and lymphatic drainage is different for each one of these malignancies (Fig. 1). In vulvar tumour, the lymphatic drainage is predominantly superficial, and the first-draining lymph nodes are usually located in the groin. Instead, the lymphatic drainage of cervical and endometrial tumours is deep, and SLNs are located along the iliac vessels as well as in other areas with complex anatomy. Therefore, the use of preoperative SPECT/CT appears to be mandatory in cervical and endometrial tumours; whereas in vulvar tumour, it is considered more optional. In addition, intraoperative imaging, such as portable gamma-camera and intraoperative 3D navigation SPECT/CT, represents complementary tools useful to guide the surgeon in patients with difficult SLN localization, such as those close to the site of the injection or in complex anatomy areas. The new hybrid tracer using indocyanine green with 99mTc-nanocolloid (ICG99mTc-nanocolloid) improves the intraoperative visualization of SLN, resulting useful during the operation. All these particular aspects of SLN procedure in gynaecological malignancies will be discussed in this review. A research of the literature was performed on PubMed/MEDLINE using the following keywords (MeSH terms) to encounter the most relevant studies about the SLN procedure in gynaecology: “SLN biopsy”, “lymphatic mapping”, “lymphoscintigraphy”, “SPECT/CT”, “intraoperative SLN detection”, “hybrid tracer”, “vulvar cancer”, “cervical cancer”, and “endometrial cancer”. The search has been restricted to the English language. The references of the retrieved articles were examined to identify additional articles. This review also includes meta-analyses published in the last five years.Fig. 1


The sentinel node approach in gynaecological malignancies
Anatomical sentinel lymph-node (SLN) distribution in gynaecological malignancies. In vulvar cancer (Ref. [48]), SLNs are limited to the groin and are predominantly found in the superior, central, and medial inferior inguinal Daseler’s zones (a). By contrast, in cervical cancer. (b) SLNs are mainly located along the iliac vessels (Ref. [15]), whereas in endometrial cancer (c) also para-aortic drainage is frequently observed (Ref. [17])
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037154&req=5

Fig1: Anatomical sentinel lymph-node (SLN) distribution in gynaecological malignancies. In vulvar cancer (Ref. [48]), SLNs are limited to the groin and are predominantly found in the superior, central, and medial inferior inguinal Daseler’s zones (a). By contrast, in cervical cancer. (b) SLNs are mainly located along the iliac vessels (Ref. [15]), whereas in endometrial cancer (c) also para-aortic drainage is frequently observed (Ref. [17])
Mentions: In gynaecological tumours, the sentinel lymph node (SLN) procedure is principally performed in vulvar cancer (VC), cervical cancer (CC), and endometrial cancer (EC). Although both preoperative lymphatic mapping and intraoperative SLN detection are common parts of SLN procedure in gynaecological tumours, the type of injection and lymphatic drainage is different for each one of these malignancies (Fig. 1). In vulvar tumour, the lymphatic drainage is predominantly superficial, and the first-draining lymph nodes are usually located in the groin. Instead, the lymphatic drainage of cervical and endometrial tumours is deep, and SLNs are located along the iliac vessels as well as in other areas with complex anatomy. Therefore, the use of preoperative SPECT/CT appears to be mandatory in cervical and endometrial tumours; whereas in vulvar tumour, it is considered more optional. In addition, intraoperative imaging, such as portable gamma-camera and intraoperative 3D navigation SPECT/CT, represents complementary tools useful to guide the surgeon in patients with difficult SLN localization, such as those close to the site of the injection or in complex anatomy areas. The new hybrid tracer using indocyanine green with 99mTc-nanocolloid (ICG99mTc-nanocolloid) improves the intraoperative visualization of SLN, resulting useful during the operation. All these particular aspects of SLN procedure in gynaecological malignancies will be discussed in this review. A research of the literature was performed on PubMed/MEDLINE using the following keywords (MeSH terms) to encounter the most relevant studies about the SLN procedure in gynaecology: “SLN biopsy”, “lymphatic mapping”, “lymphoscintigraphy”, “SPECT/CT”, “intraoperative SLN detection”, “hybrid tracer”, “vulvar cancer”, “cervical cancer”, and “endometrial cancer”. The search has been restricted to the English language. The references of the retrieved articles were examined to identify additional articles. This review also includes meta-analyses published in the last five years.Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

This review discusses the state-of-the-art of sentinel lymph node mapping in gynaecological malignancies, including cervical cancer, endometrial cancer, and vulvar cancer, with an emphasis on new technological advances. For this objective, PubMed/MEDLINE was searched for relevant studies about the sentinel lymph node procedure in gynaecology. In particular, the use of preoperative lymphatic mapping with lymphoscintigraphy and single photon emission tomography/computed tomography (SPECT/CT) was identified in 18 studies. Other recent advances as hybrid tracers (e.g. ICG-99mTc-nanocolloid) and intraoperative tools (portable γ-camera and 3D navigation devices) appear to also represent a useful guide for the surgeon during the operation. Concerning vulvar and cervical cancers, the sentinel lymph node procedure has been incorporated to the current guidelines in Europe and North America, whereas for endometrial cancer it is considered investigative.

No MeSH data available.


Related in: MedlinePlus