Sentinel lymph node biopsy in endometrial and cervical cancer: current and controversial issues

The authors review the controversial issues regarding the management algorithms, the impact of ultrastaging to adjuvant treatment, and outcomes from the role of sentinel lymph nodes (SLN) in endometrial cancer (EC) and cervical cancer (CC). According to standard recommendation, side specific nodal resection is required in case of failed mapping. Alternative algorithms were proposed to reduce overtreatment in low risk EC and CC. The positive results of new algorithms may lead to a proper selection of patients in which pelvic lymphadenectomy could be avoided. Ultrastaging had an impact on accuracy by increasing the detection rate by 25-50%. Occult LN metastasis was associated with myometrial invasion in EC, but the relationships between other known factors of CC recurrence are unclear. Prognosis for the patient with either EC or CC in SLN algorithm group was similar to those in the lymphadenectomy group while the latter group had shown a higher surgical morbidity.