| Procedure | Indication | Execution |
|---|---|---|
| Sentinel Lymph Node Biopsy | - Tumor FIGO IA1 with L1, IA2, IB1 (<2 cm). - No proven lymph node metastases. - Bilateral sentinel lymph node detection possible. | - Identification of sentinel lymph nodes with radioactive tracer, indocyanine green, or patent blue. - Removal and histological examination. |
| Pelvic Lymphadenectomy | - Tumor >2 cm or proven lymph node metastases. - Inadequate sentinel lymph node detection. - High-risk patients (e.g., L1, deep stromal infiltration). | - Systematic removal of obturator, iliac, and para-iliac lymph nodes. |
| Para-aortic Lymphadenectomy | - Proven pelvic lymph node metastases. - Tumor stage ≥ FIGO IIB. - Tumor size >4 cm with suspected lymph node involvement. | - Removal of para-aortic lymph nodes up to the level of the renal arteries. |
Important Decision Criteria:
- If the sentinel node is negative, systematic pelvic LNE can be omitted.
- If no sentinel lymph node is found, systematic LNE is necessary.
- Para-aortic lymphadenectomy only in confirmed pelvic metastases to optimize staging and therapy strategy (e.g., radiochemotherapy).
Reference:
- Lecuru, F., et al., Bilateral negative sentinel nodes accurately predict absence of lymph node metastasis in early cervical cancer: results of the SENTICOL study. J Clin Oncol, 2011. 29(13): p. 1686-91
- Denschlag, D., J. Woll, and A. Schneider, Importance of the Sentinel Lymph Node Concept in Uterine Carcinomas. Frauenarzt, 2011. 52(1): p. 46-51.
- Altgassen, C., et al., Multicenter validation study of the sentinel lymph node concept in cervical cancer: AGO Study Group. J Clin Oncol, 2008. 26(18): p. 2943-51.
- Ruscito, I., et al., Sentinel Node Mapping in Cervical and Endometrial Cancer: Indocyanine Green Versus Other Conventional Dyes-A Meta-Analysis. Ann Surg Oncol, 2016. 23(11): p. 3749-3756.
- Guideline Program Oncology (German Cancer Society, German Cancer Aid, AWMF): S3 Guideline Diagnosis, Therapy, and Follow-up of Patients with Cervical Cancer, Long Version 2.2, 2022, AWMF Register Number: 032/033OL