Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr. Rossi).
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University, Chicago, Illinois (Dr. Tanner).
J Minim Invasive Gynecol. 2021 Mar;28(3):409-417. doi: 10.1016/j.jmig.2020.12.025. Epub 2020 Dec 24.
Sentinel lymph node (SLN) biopsy represents an evolution in the advancement of minimally invasive surgical techniques for gynecologic cancers. Prospective and retrospective studies have consistently shown its accuracy in the detection of lymph node metastases for endometrial and cervical cancers. However, consistent with any emerging surgical technique in the early phases of adoption, new questions have arisen regarding its application and impact. This paper served as a scoping review to identify the key controversies that have arisen in the field of SLN biopsy for endometrial and cervical cancers.
Several key controversies were identified, and PubMed, the Cochrane Library (cochranelibrary.com) advanced search function, and the National Comprehensive Cancer Network guidelines were searched for supporting evidence. These included search terms such as "the accuracy of SLN biopsy for high grade endometrial cancer or cervical cancers >2-cm," "cost effectiveness of SLN biopsy for gynecologic cancers," "clinical significance of low volume metastases in endometrial cancer," "morbidity of SLN biopsy for endometrial and cervical cancer," and "impact on cancer survival of SLN biopsy for endometrial and cervical cancer."
Studies were selected for review if they included significant numbers of patients, were level I evidence, or were prospective trials. Where this level of evidence failed to exist, seminal observational series that were published in high-quality journals were included.
TABULATION, INTEGRATION, AND RESULTS: Similar studies were listed and subcategorized and cross-compared, excluding those that included repeated analyses of the same patient populations. The relevant clinical trials or observational studies were clustered and reviewed for each chosen controversy. Adequate evidence supports the accuracy of SLN biopsy in the staging of high-grade endometrial cancer and cervical cancer, and it seems to be a cost-effective strategy for invasive endometrial cancer. Conclusive evidence was lacking with respect to the oncologic outcomes related to SLN biopsy, the impact on patient morbidity, and whether clinicians should treat isolated tumor cells in SLNs with adjuvant therapy.
SLN biopsy is an accepted staging strategy for cervical and endometrial cancer surgery; however, controversies remain in how it can be applied with the most safety and efficacy. These ultimately need to be resolved with further clinical trials and observations of larger series of patients.
前哨淋巴结（SLN）活检代表了微创外科技术在妇科癌症中的发展演进。前瞻性和回顾性研究一致表明，它在检测子宫内膜癌和宫颈癌的淋巴结转移方面具有准确性。然而，与任何新兴的外科技术在早期采用阶段一样，新的问题也随之出现，涉及到其应用和影响。本文旨在进行范围界定审查，以确定 SLN 活检在子宫内膜癌和宫颈癌领域中出现的主要争议。
确定了几个关键争议点，并对 PubMed、Cochrane 图书馆（cochranelibrary.com）高级搜索功能以及国家综合癌症网络指南进行了检索，以寻找支持证据。这些搜索词包括“高级别子宫内膜癌或>2cm 宫颈癌的 SLN 活检准确性”、“妇科癌症 SLN 活检的成本效益”、“子宫内膜癌中低体积转移的临床意义”、“子宫内膜癌和宫颈癌的 SLN 活检的发病率”以及“子宫内膜癌和宫颈癌的 SLN 活检对癌症生存的影响”。
如果研究纳入了大量患者、为一级证据或为前瞻性试验，则选择进行综述。在缺乏此类证据的情况下，纳入发表在高质量期刊上的重要观察性系列研究。
列表、整合和结果：列出了相似的研究，并进行了分类和交叉比较，排除了那些对同一患者群体进行重复分析的研究。对每个选定的争议，对相关的临床试验或观察性研究进行了聚类和综述。有足够的证据支持 SLN 活检在高级别子宫内膜癌和宫颈癌分期中的准确性，并且对于侵袭性子宫内膜癌来说，它似乎是一种具有成本效益的策略。关于 SLN 活检相关的肿瘤学结果、对患者发病率的影响以及临床医生是否应在 SLN 中用辅助治疗治疗孤立肿瘤细胞，尚缺乏确凿的证据。
SLN 活检是宫颈癌和子宫内膜癌手术的一种公认的分期策略；然而，在如何以最安全和有效的方式应用 SLN 活检方面仍存在争议。这些争议最终需要通过进一步的临床试验和对更大系列患者的观察来解决。
