Clinical Review

Lymphatic mapping: finding the sentinel node

OBG Manag. 2002 July;14(7):82-90

References

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Lymphatic mapping is not recommended for patients with advanced tumors and no obvious injection site, patients with grossly involved lymph nodes, or patients who have undergone previous vulvar or groin surgery that may have altered the lymphatic drainage. Because wide local excision may interfere with lymphatic mapping in patients with vulvar cancer, it is advisable to perform only a punch biopsy when suspicious vulvar lesions are present before referring the patient to a gynecologic oncologist.

TABLE 1

Lymphatic mapping of the vulva: results of published series

SERIES	PATIENTS IN WHOM SN IDENTIFIED(%)	TOTAL NUMBER OF CASES	GROINS IN WHICH SN IDENTIFIED(%)	TOTAL NUMBER OF GROINS
Barton et al¹⁵	90	10	—	Not stated
DeCesare et al¹⁶	100	11	100	14
Terada et al¹⁷	100	9	100	12
DeCicco et al¹³	100	37	100	55
Ansink et al¹⁸	Not stated	51	56	93
de Hullu et al¹²	100	59	89	107
Levenback et al¹⁴	88	52	75	76
SN=sentinel node

Cervical cancer

The cervix is a midline structure with complex lymphatic drainage. Thus, in patients with cervical cancer, an extensive nodal dissection is required to remove all potential sites of metastatic disease. Regional therapy is curative if the extent of disease is accurately established.

Several feasibility trials have been reported.^19-25 In addition, the first laparoscopic gamma probes are now available, allowing 2 minimally invasive techniques to be combined: lymphatic mapping and operative laparoscopy.

Unfortunately, questions remain about the usefulness of lymphatic mapping in cervical cancer patients. That is because lower-extremity lymphedema is not as common following pelvic lymphadenectomy as it is following inguinal femoral lymphadenectomy. However, the determination of lymph node status could help triage patients between radical surgery and regional radiotherapy.

Future directions

In the coming years, gynecologists should look for increasing use of lymphatic mapping in patients with solid tumors. One of the great promises of lymphatic mapping is the ability to detect smaller and smaller metastases. For example, investigators have found human Papillomavirus DNA and cytokeratin RNA in lymph nodes from cervical cancer patients with “negative” biopsy findings after standard histologic examination. The clinical significance of these socalled biologically positive lymph nodes is not known at present. However, there will be increasing application of new molecular biologic techniques to the analysis of sentinel nodes.

The author reports no financial relationship with any companies whose products are mentioned in this article.