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Sentinel node technique in uterine cancers

Epublication WebSurg.com, Apr 2012;12(04). URL: http://websurg.com/doi/lt03enquerleu002

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Standard full pelvic lymph node dissection is a simple operation but with potential complications, such as lymphedema, which can be very disturbing for the patient. Additionally, even full pelvic dissection may miss the so-called “ectopic nodes”. Moreover, if a large number of nodes are sent for pathological exam, the pathologist is unable to perform serial sections and immunohistochemistry (IHC) to all nodes. For that reason, the pathologist could well miss positive nodes. On the other hand, the sentinel node technique is able to detect the nodes that are not included in standard pelvic node dissection. It is also able to diagnose micro-metastasis on serial sections. This technique, which is performed laparoscopically, uses blue dye combined with radio-isotopic identification and mapping, potentially associated with planar lymphoscintigraphy and SPECT-CT. In this way, it is possible to also detect “hot” nodes that are not colored by blue dye. The injection is performed in each quadrant of the cervix, approximately 2mm deep in the stroma. In the near future, the sentinel node will probably have become the only one to be removed in early cervical cancer as well as in low and intermediate risk endometrial cancer.