Sentinel lymph node (SLN) concept in cervical cancer: Current limitations and unanswered questions.

Abstract Sentinel lymph node (SLN) biopsy has been increasingly used in the management of early-stages cervical cancer instead of systematic pelvic lymph node dissection (PLND). The aim of this article is to give a critical overview of key aspects related to this concept, such as a necessity for reliable detection of micrometastases (MIC) in SLN and the requirements for SLN pathologic ultrastaging, low accuracy of intraoperative detection of SLN involvement, and still a limited evidence of oncological safety of the replacement of PLND by SLN biopsy only in ≥IB1 tumours due to unknown risk of MIC in non-SLN pelvic lymph nodes in patients with negative SLN, and absence of any prospective evidence. Highlights • Detection of micrometastases increases sensitivity of SLN, so SLN ultrastaging should be performed if PLND is avoided. • Intraoperative SLN evaluation fails to detect 30–50% of metastases. • Micrometastases in SLN is associated with decreased survival equivalent to macrometastases. • The risk of micrometastases in pelvic LN in cases with negative SLN is not known. • There is no prospective evidence on safety of SLN only concept in cervical cancer. [ABSTRACT FROM AUTHOR]