[The role of sentinel lymph node biopsy in the management of gynecologic cancers: current evidence and institutional experience].

Abstract

Objective: To critically review the current role of sentinel lymph node (SLN) biopsy in endometrial, cervical, vulvar and ovarian cancer, and to compare international evidence with a single institution's surgical experience.

Methods: Targeted appraisal of randomized trials, prospective cohorts, systematic reviews and meta-analyses, complemented by retrospective, descriptive institutional data on 141 patients (indocyanine green mapping; robotic and laparoscopic platforms).

Results: In endometrial cancer, available prospective and meta-analytic data indicate that SLN biopsy is not associated with worse oncologic outcomes than systematic lymphadenectomy. In early cervical cancer, a recent randomized trial showed that SLN biopsy alone is non-inferior to lymphadenectomy while reducing surgical morbidity. In appropriately selected vulvar cancer, groin de-escalation provides the clearest morbidity benefit. In ovarian cancer, the technique remains investigational. The institutional bilateral detection rate (78.7%) was consistent with contemporary international data.

Conclusions: SLN biopsy is a key surgical de-escalation strategy in gynecologic oncology which, with adequate pathological ultrastaging, also improves oncologic staging accuracy; its success depends on patient selection and centre experience.