Finding the sentinel lymph node in cervical cancer

In cervical cancer, it's paramount to find out if cancer cells have spread to the lymph nodes. This helps to determine how advanced the cancer is and if extra treatment is needed. In the past, we would remove many of the lymph nodes near the cancer to check for spread. But now, a relative new procedure within cervical cancer called the "sentinel lymph node procedure" is increasingly used. This procedure tries to find and remove only the first lymph nodes that the cancer would have spread to. However, for cervical cancer, there isn't enough proof yet that this new procedure is safe to use instead of the old one. One of the reasons is because we still don't fully understand how the lymph drainage from the cancer to the lymph nodes in the pelvis (near the cervix) work, and sometimes the sentinel lymph nodes are found in unusual places.

The research group of the Queen Elizabeth Hospital (S. Rundle, Gateshead, UK) and Radboudumc (Anke Smits, Mieke ten Eikelder, Petra Zusterzeel, Gynaecological Oncology) wanted to find out how often sentinel lymph nodes were found in unusual places in cervical cancer patients. In addition, we investigated which factors are associated with finding sentinel nodes in unusual places through a retrospective cohort study and literature review.

Our research showed that in 38% (38/100) of the included cervical cancer patients, sentinel lymph nodes were found in an unusual place. We also found that having a higher body mass index, never having given birth, and having a tumour larger than 20 mm were factors that increased the likelihood of finding sentinel lymph nodes in unusual places. This indicates that aberrant drainage patterns are more common than previously thought, and our study aims to improve identification of these lymph nodes by highlighting the associated factors and prevalence. Ultimately, we hope that our findings will lead to better detection of cancer spread and improved safety of the sentinel lymph node procedure in cervical cancer.

Publication

Smits A, Ten Eikelder M, Dhanis J, Moore W, Blake D, Zusterzeel P, Kucukmetin A, Ratnavelu N, Rundle S. Finding the sentinel lymph node in early cervical cancer: When is unusual not uncommon? Gynecol Oncol. 2023 Mar;170:84-92. doi: 10.1016/j.ygyno.2022.12.013. Epub 2023 Jan 17. PMID: 36657244.

Photo: Pelvic lymph node mapping met indocyanine green.