Sentinel lymph node biopsy in gynecologic cancers

Abstract

Sentinel lymph node (SLN) biopsy has emerged as a promising, less morbid alternative to complete lymphadenectomy in gynecologic oncology, enabling accurate nodal staging with a reduced surgical burden. Its use has expanded across endometrial, cervical, vulvar, and selected ovarian malignancies. Recent reviews suggest that SLN mapping can lower treatment-related morbidity without compromising oncologic outcomes. However, several challenges persist, including mapping failure, false-negative results, operator learning curves, variability in tracer techniques, and inconsistencies in ultrastaging interpretation. In early-stage cervical cancer, comparative studies demonstrate no significant differences in progression-free or overall survival between SLN biopsy alone and SLN combined with pelvic lymphadenectomy, supporting its use in carefully selected patients. In endometrial cancer, the FIRES trial reported a sensitivity of 97.2% and a negative predictive value of 99.6% with indocyanine green mapping. In response, emerging consensus guidelines aim to standardize SLN assessment to ensure diagnostic accuracy. Nevertheless, global surveys reveal substantial variation in the adoption of SLN strategies across regions and practice settings. While negative sentinel nodes generally obviate the need for further treatment, the detection of micro metastases-particularly in cervical and endometrial cancers-has gained clinical importance, often prompting adjuvant radiotherapy and/or chemotherapy. As precision surgery continues to evolve, this editorial explores whether the current evidence, infrastructure, and multidisciplinary preparedness are sufficient for SLN biopsy to become standard practice, or whether it remains an innovation still awaiting widespread readiness.

Keywords: Sentinel lymph node biopsy; Gynecological cancers; Cervical cancer; Endometrial cancer; Vulval cancer; Ovarian cancer

Core Tip: Sentinel lymph node (SLN) biopsy is redefining nodal staging in gynecologic oncology by reducing surgical morbidity without compromising oncologic outcomes. Evidence supports its use in early-stage cervical and endometrial cancers, with high diagnostic accuracy and survival equivalence to full lymphadenectomy in selected patients. However, technical variability, learning curves, and inconsistent global adoption remain barriers. As micrometastatic disease increasingly influences adjuvant treatment decisions, the challenge is no longer proof of concept, but whether health systems are ready to implement SLN biopsy as routine standard care.