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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.

No MeSH data available.


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In a patient with vulvar cancer, delayed planar imaging (a) shows one SLN in the right groin (red arrow) corresponding with one allocated SLN uptake (red arrow) on transversal-fused SPECT/CT (b) and two not enlarged lymph nodes on transversal CT (c) (double arrows). In another patient, delayed planar image (d) shows unilateral lymphatic drainage with a single SLN in the right groin (red arrow), while transversal-fused SPECT/CT (e) shows bilateral drainage with also a contralateral SLN (red arrow) corresponding with a not enlarged lymph node in the left groin on CT (f)
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Fig4: In a patient with vulvar cancer, delayed planar imaging (a) shows one SLN in the right groin (red arrow) corresponding with one allocated SLN uptake (red arrow) on transversal-fused SPECT/CT (b) and two not enlarged lymph nodes on transversal CT (c) (double arrows). In another patient, delayed planar image (d) shows unilateral lymphatic drainage with a single SLN in the right groin (red arrow), while transversal-fused SPECT/CT (e) shows bilateral drainage with also a contralateral SLN (red arrow) corresponding with a not enlarged lymph node in the left groin on CT (f)

Mentions: As reported in the current literature, SPECT/CT plays an important role to provide a better anatomical localization of SLN(s) and to detect additional lymph nodes in the same region or in other regions with poor or even without visualization at planar lymphoscintigraphy (Fig. 4), as well as to reduce the false positive rate possibly due to external contamination or presence of radioactivity in enlarged lymphatic vessels, [16, 19, 46, 47]. Recently, Collarino et al. reported the use of SPECT/CT for anatomical mapping of lymphatic drainage in vulvar cancer. According to the five Daseler zones using the inguinal saphenofemoral junction as anatomical reference, the authors found that the lymphatic drainage was principally to the medial inguinal region (83 %), and the drainage to the lateral inferior groin was only incidental (0.5 %) in 83 patients with cN0 vulvar cancer (Fig. 1). Further drainage to higher echelon nodes was visualized in the groin (15 %) and in the pelvis (85 %). Therefore, SPECT/CT is able to personalize the lymphatic mapping, and has a potential role in limiting the extent of lymph node dissection to the lateral inferior zone in patients with positive SLN(s) [48] (Table 3).Fig. 4


The sentinel node approach in gynaecological malignancies
In a patient with vulvar cancer, delayed planar imaging (a) shows one SLN in the right groin (red arrow) corresponding with one allocated SLN uptake (red arrow) on transversal-fused SPECT/CT (b) and two not enlarged lymph nodes on transversal CT (c) (double arrows). In another patient, delayed planar image (d) shows unilateral lymphatic drainage with a single SLN in the right groin (red arrow), while transversal-fused SPECT/CT (e) shows bilateral drainage with also a contralateral SLN (red arrow) corresponding with a not enlarged lymph node in the left groin on CT (f)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: In a patient with vulvar cancer, delayed planar imaging (a) shows one SLN in the right groin (red arrow) corresponding with one allocated SLN uptake (red arrow) on transversal-fused SPECT/CT (b) and two not enlarged lymph nodes on transversal CT (c) (double arrows). In another patient, delayed planar image (d) shows unilateral lymphatic drainage with a single SLN in the right groin (red arrow), while transversal-fused SPECT/CT (e) shows bilateral drainage with also a contralateral SLN (red arrow) corresponding with a not enlarged lymph node in the left groin on CT (f)
Mentions: As reported in the current literature, SPECT/CT plays an important role to provide a better anatomical localization of SLN(s) and to detect additional lymph nodes in the same region or in other regions with poor or even without visualization at planar lymphoscintigraphy (Fig. 4), as well as to reduce the false positive rate possibly due to external contamination or presence of radioactivity in enlarged lymphatic vessels, [16, 19, 46, 47]. Recently, Collarino et al. reported the use of SPECT/CT for anatomical mapping of lymphatic drainage in vulvar cancer. According to the five Daseler zones using the inguinal saphenofemoral junction as anatomical reference, the authors found that the lymphatic drainage was principally to the medial inguinal region (83 %), and the drainage to the lateral inferior groin was only incidental (0.5 %) in 83 patients with cN0 vulvar cancer (Fig. 1). Further drainage to higher echelon nodes was visualized in the groin (15 %) and in the pelvis (85 %). Therefore, SPECT/CT is able to personalize the lymphatic mapping, and has a potential role in limiting the extent of lymph node dissection to the lateral inferior zone in patients with positive SLN(s) [48] (Table 3).Fig. 4

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