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ISRN Surgery  2014 

Sentinel Lymph Node Biopsy in Uterine Cervical Cancer Patients: Ready for Clinical Use? A Review of the Literature

DOI: 10.1155/2014/841618

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Abstract:

Sentinel lymph node biopsy has been widely studied in a number of cancer types. As far as cervical cancer is concerned, this technique has already been used, revealing both positive results and several issues to be solved. The debate on the role of sentinel lymph node biopsy in cervical cancer is still open although most of the studies have already revealed its superiority over complete lymphadenectomy and the best handling possible of the emerging practical problems. Further research should be made in order to standardize this method and include it in the clinical routine. 1. Introduction Cervical carcinoma is the commonest gynaecological cancer worldwide with almost 500.000 new cases per year and is particularly prevalent in the developing countries [1]. It is the tenth most common cancer affecting women in the developed countries [2]. The number of young women with cervical cancer has increased in recent years [3]. Thus, the effective use of screening has led to a rising number of women with cervical cancer being diagnosed in an early stage of the disease. Therefore, such patients must survive with treatment-associated sequelae for a long time and, in this way, prevention of some of these sequelae is important for this population. Lymph node metastasis is a central phenomenon in the natural history of patients with cervical cancer. The International Federation of Gynecology and Obstetrics (FIGO) staging system does not include lymph node status, but lymph node metastasis remains the most important risk factor for recurrence and death in surgically treated patients with early cervical cancer. The sentinel lymph node (SLN) is the first node draining the lymphatic flow from a primary tumor and represents the status of lymphatic spread [4, 5]. Therefore, if the sentinel node is negative, the remainder of the lymph nodes in the nodal basin should be free of disease as well, and it would not be reasonable to perform complete lymphadenectomy in case of negative sentinel lymph node. Cervical cancer is a good candidate disease for lymphatic mapping because of the following. Firstly, cervix has a complex lymphatic drainage due to its midline position. Secondly, conventional imaging techniques fail to identify with accuracy lymph node metastases. Thirdly, the incidence of nodal metastases in patients with tumor size less than or equal to 2?cm is 0–16% and in patients with stage IB is 15–31%. This means that a great number of patients with negative nodes will derive no benefit from lymphadenectomy [6]. On the contrary, they suffer from the possible side-effects

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