Sentinel lymph node (SLN) concept in cervical cancer: Current limitations and unanswered questions

Sentinel lymph node (SLN) biopsy has been increasingly used in the management of early-stages cervical cancer instead of systematic pelvic lymph node dissection (PLND). The aim of this article is to give a critical overview of key aspects related to this concept, such as a necessity for reliable detection of micrometastases (MIC) in SLN and the requirements for SLN pathologic ultrastaging, low accuracy of intraoperative detection of SLN involvement, and still a limited evidence of oncological safety of the replacement of PLND by SLN biopsy only in ≥IB1 tumours due to unknown risk of MIC in non-SLN pelvic lymph nodes in patients with negative SLN, and absence of any prospective evidence. •Detection of micrometastases increases sensitivity of SLN, so SLN ultrastaging should be performed if PLND is avoided.•Intraoperative SLN evaluation fails to detect 30–50% of metastases.•Micrometastases in SLN is associated with decreased survival equivalent to macrometastases.•The risk of micrometastases in pelvic LN in cases with negative SLN is not known.•There is no prospective evidence on safety of SLN only concept in cervical cancer.