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1185 Sentinel lymph node staging in early-stage cervical cancer: a systematic review
  1. Chrysoula Margioula-Siarkou1,
  2. Aristarchos Almperis2,
  3. Emmanouela-Aliki Almperi2,
  4. Georgia Margioula-Siarkou2,
  5. Stefanos Flindris3,
  6. Giuseppe Gullo4,
  7. Konstantina Mponiou5,
  8. Pavlos Papakotoulas6,
  9. Konstantinos Dinas1 and
  10. Stamatios Petousis1
  1. 12nd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
  2. 22nd Department of Obsetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
  3. 32nd Department of Obstetrics and Gynecology, Ippokratio Hospital of Thessaloniki, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece, Thessaloniki, Greece
  4. 4Department of Gynaecologic Oncology, Palermo, Italy
  5. 5Radiation Oncology Unit, Theageneio Anticancer Hospital, Thessaloniki, Greece
  6. 6Medical Oncology Unit, Theageneio Anticancer Hospital, Thessaloniki, Greece


Introduction/Background Current guidelines suggest full pelvic lymphadenectomy (PLND) for lymph node staging in early-stage cervical cancer (CC) patients. Main objective of this review is to consolidate existing evidence on the diagnostic precision and survival results of sentinel lymph node biopsy (SLNB) compared to radiographic nodal assessment and systematic lymphadenectomy.

Methodology A systematic review through PubMed, Scopus and EMBASE was carried out up to July 2023 scrutinizing the application of SLNB in women with early-stage CC focusing on the comparison with PET/CT and PLND. Eligible studies included prospective and retrospective randomized control trials (RCTs), cohort studies, case-control and case series studies, as well as systematic review articles and meta-analyses, having as primary objective to compare survival outcomes and diagnostic accuracy in terms of false-positive, false negative rates (FPR, FNR), sensitivity and specificity. Additionally, studies investigating low-volume disease in sentinel nodes and its impact on survival outcomes or recurrence risk were also considered eligible.

Results There were finally 10 articles meeting the inclusion criteria, among which, 4 studies highlighted SLNB’s superior accuracy in determining lymph node status for primary CC compared to advanced imaging methods, with PET being regarded as the optimal choice. In 1 systematic review and one meta-analysis, SLNB shows comparable oncologic efficacy to PLND, exhibiting higher positive node detection and pre-dominance of no lymph node recurrences. However, due to the lack of robust prospective evidence, especially regarding long-term oncological safety, SLNB hasn’t attained gold standard status. Regarding low-volume disease impact, 4 cohort studies presented conflicting findings: micrometastases (MIC) were linked to both increased and decreased survival rates or acted as an independent recurrence risk factor.

Conclusion This critical review strongly supports the safety and efficacy of SLNB over imaging staging in early-stage CC. Abandoning PLND in early-stage CC isn’t justified per major guidelines. Further multicenter RCTs are needed for conclusive evidence.

Disclosures Authors have nothing to disclose.

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