Our Summary

This research paper discusses the use of sentinel lymph node (SLN) biopsy in assessing early-stage cervical cancer in women. The lymph node status plays a significant role in predicting survival rates for these patients. Traditionally, the entire lymph node system in the pelvis would be dissected to check for cancer spread (a process called pelvic lymph node dissection or PLND), but this can lead to complications and lower quality of life for patients.

The SLN biopsy is a less invasive method that can provide detailed information about the lymph nodes and the spread of the cancer, including small, difficult-to-detect tumors. It can also identify lymph nodes that are often missed in regular dissections. To ensure that the SLN biopsy is accurate, the patient selection, training, and rules need to be carefully managed to avoid false negatives.

While the combination of a radioactive substance (technetium-99) and a blue dye is commonly used to detect the SLN, a fluorescent dye called indocyanine green (ICG) is showing promise in improving detection rates.

However, despite its advantages, the use of SLN biopsy alone is not yet considered the best standard treatment due to lack of long-term safety data. There are also controversies such as its accuracy during surgery and the impact of small, spread-out tumors on prognosis. A clinical trial called SENTICOL III aims to address these issues.

FAQs

  1. What is a sentinel lymph node (SLN) biopsy and how does it help in assessing early-stage cervical cancer?
  2. What are some potential advantages and disadvantages of using SLN biopsy instead of traditional pelvic lymph node dissection (PLND)?
  3. What is the role of the substances like technetium-99, blue dye, and indocyanine green (ICG) in SLN biopsy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about sentinel lymph node biopsy is to make sure to discuss all potential risks and benefits with your healthcare provider before undergoing the procedure. It is important to follow any pre-operative instructions provided by your doctor, such as fasting before the procedure and avoiding certain medications. Additionally, be sure to inform your healthcare team of any allergies or medical conditions you may have. After the procedure, it is important to follow post-operative care instructions closely to ensure proper healing and minimize the risk of complications.

Suitable For

Patients who are typically recommended for sentinel lymph node biopsy include those with early-stage cervical cancer who are at low to intermediate risk of lymph node involvement. This includes patients with small tumors, negative lymph nodes on imaging studies, and no evidence of metastasis. Patients who are considered high-risk, such as those with larger tumors, lymphovascular invasion, or deep stromal invasion, may still undergo pelvic lymph node dissection to ensure a more thorough assessment of lymph node status. Additionally, patients who have undergone neoadjuvant chemotherapy or radiation therapy may not be suitable candidates for SLN biopsy. Overall, patient selection for SLN biopsy should be individualized based on the specific characteristics of the tumor and the patient’s overall health status.

Timeline

Before the sentinel lymph node biopsy:

  1. Patient is diagnosed with early-stage cervical cancer.
  2. Patient undergoes imaging scans to determine the extent of the cancer.
  3. Patient discusses treatment options with their healthcare team, including the possibility of a sentinel lymph node biopsy.
  4. Patient may receive preoperative counseling and education about the procedure.

After the sentinel lymph node biopsy:

  1. Patient undergoes the SLN biopsy procedure, which involves injecting a radioactive substance and/or dye near the tumor site to identify the sentinel lymph node.
  2. The SLN is removed and examined for cancer cells.
  3. Depending on the results, further treatment options, such as surgery, radiation therapy, or chemotherapy, may be recommended.
  4. Patient may experience side effects such as pain, swelling, or infection at the biopsy site.
  5. Patient undergoes regular follow-up appointments to monitor their recovery and cancer status.
  6. Long-term outcomes, such as survival rates and quality of life, are monitored to assess the effectiveness of the SLN biopsy in managing early-stage cervical cancer.

What to Ask Your Doctor

Some questions a patient should ask their doctor about sentinel lymph node biopsy include:

  1. What is the purpose of a sentinel lymph node biopsy in my specific case?
  2. What are the potential risks and complications associated with the procedure?
  3. How accurate is the sentinel lymph node biopsy in detecting cancer spread compared to traditional pelvic lymph node dissection?
  4. Will I need any special preparation before the biopsy, such as avoiding certain medications or foods?
  5. How is the radioactive substance or dye injected for the biopsy, and what should I expect during the procedure?
  6. How long will it take to receive the results of the biopsy?
  7. What are the possible next steps if the biopsy results show cancer spread to the sentinel lymph nodes?
  8. Are there any alternative options to sentinel lymph node biopsy that I should consider?
  9. Will I need any follow-up appointments or treatments after the biopsy?
  10. Are there ongoing clinical trials or research studies related to sentinel lymph node biopsy that I should be aware of?

Reference

Authors: Balaya V, Guani B, Bonsang-Kitzis H, Deloménie M, Ngô C, Montero Macias R, Koual M, Nguyen-Xuan HT, Bats AS, Mathevet P, Lécuru F. Journal: Bull Cancer. 2020 Jun;107(6):696-706. doi: 10.1016/j.bulcan.2019.06.011. Epub 2019 Oct 15. PMID: 31627905