Sentinel lymph node mapping in the modern management of gynaecological malignancy

Abstract

Key content Sentinel lymph node (SLN) biopsy is an alternative to systematic lymphadenectomy in the surgical staging of gynaecological malignancy. It is recommended in the management of vulval cancer and is increasingly used in endometrial and cervical cancer. SLN failed mapping algorithms require that side‐specific lymphadenectomy should be performed in the case of failed mapping, and that suspicious lymph nodes are removed. Ultrastaging protocols improve detection of lymph‐node metastasis and should be used for the pathological processing of SLNs. Learning objectives To understand the rationale, use and evidence for SLN biopsy in women with vulval, cervical and endometrial malignancy. To appreciate the concepts behind the technical performance of SLN biopsy. To understand the pathological processing of SLN samples and the implications this may have for the interpretation of results and adjuvant therapy. Ethical issues How to manage adjuvant therapy decisions in the context of micrometastases or isolated tumour cells in positive pelvic SLNs in cervical or endometrial cancer when the evidence‐base is limited.