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Survival after sentinel node biopsy alone in early-stage cervical cancer: a systematic review
  1. Jessica Mauro1,2,
  2. David Viveros-Carreño3,4,
  3. Giuseppe Vizzielli5,
  4. Elena De Ponti6,
  5. Francesco Fanfani7,
  6. Pedro T Ramirez8 and
  7. Alessandro Buda1
  1. 1 Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Italy
  2. 2 University of Udine, Udine, Italy
  3. 3 Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, Colombia
  4. 4 Gynecologic Oncology, Clínica Universitaria Colombia and Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo - CTIC, Bogotá, Colombia
  5. 5 Obstetrics and Gynecology, University of Udine, Santa Maria della Misericordia Hospital, Udine, Italy
  6. 6 Department of Physical Medicine, San Gerardo Hospital, Monza, Italy
  7. 7 Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
  8. 8 Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas, USA
  1. Correspondence to Dr Alessandro Buda, Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Italy; alebuda1972{at}gmail.com

Abstract

Objective To assess the oncologic outcomes of sentinel lymph node biopsy alone as part of surgical management in patients with early-stage cervical cancer.

Methods A systematic search of the literature was performed following the PRISMA checklist. MEDLINE (through PubMed), EMBASE, and Scopus databases were searched from June 1991 to May 2023. Studies of women with early-stage cervical cancer International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IA–IIA, of any age or histology, and articles only in English language were included. After the removal of duplicates, only articles including sentinel node mapping alone compared with full pelvic lymphadenectomy were retained.

Results Four studies with a total of 2226 patients were included. Among these, 354 (15.9%) underwent sentinel lymph node biopsy alone. A total of 2210 (99.2%) patients had FIGO 2009 stage I disease and 1514 (68%) patients had squamous cell carcinoma. Median body mass index was 25.5 kg/m2 (range 23.5–27). Lymph vascular space invasion was present in 633 patients (34%) who underwent full lymphadenectomy and in 78 patients (22%) who underwent sentinel node biopsy alone. The results of the survival analysis showed that there was no significant difference in the 3-year progression-free survival rates of patients who underwent either sentinel biopsy alone or lymphadenectomy. Three-year recurrence-free survival was 93.1% (95% CI 28.3% to 64.7%) for patients who underwent sentinel node biopsy alone and 92.5% (95% CI 39.0% to 53.4%) for patients who underwent sentinel node biopsy and lymphadenectomy (p=0.773).

Conclusions In patients with early-stage cervical cancer, performing sentinel lymph node biopsy alone compared with pelvic lymphadenectomy does not appear to independently confer a higher risk or recurrence.

  • cervical cancer
  • sentinel lymph node
  • SLN and lympadenectomy

Data availability statement

Data are available on reasonable request. In accordance with the journal’s guidelines, we will provide our data for independent analysis by a selected team by the Editorial Team for the purposes of additional data analysis or for the reproducibility of this study in other centers if such is requested.

http://dx.doi.org/10.1136/ijgc-2023-004692

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    Data availability statement

    Data are available on reasonable request. In accordance with the journal’s guidelines, we will provide our data for independent analysis by a selected team by the Editorial Team for the purposes of additional data analysis or for the reproducibility of this study in other centers if such is requested.

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    Footnotes

    • Twitter @frafanfani, @pedroramirezMD

    • Contributors Conceptualization: JM, AB. Data curation: JM, EDP, AB. Formal analysis: EDP. Investigation: JM, DV-C, GV, PTR, EDP, FF, AB. Methodology: JM, AB, GV, EDP, DV-C, PTR. Supervision: DV-C, PTR, GV, FF. Writing - original draft: JM, AB. Writing - review and editing: JM, AB, GV, DV-C, PTR. Responsible for the overall content as guarantor: AB.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.