Sentinel Lymph Node Dissection-Novelty, Trend, or a Paradigm Shift in Surgical Decision-Making for Early Cervical Cancer?

Cervical cancer remains the fourth most common malignancy among women worldwide, with over 600,000 new cases and approximately 350,000 deaths in 2022. Lymph node (LN) status is a critical prognostic factor, and in 2018, the International Federation of Gynecology and Obstetrics (FIGO) revised its staging system to include regional LN metastases, underscoring the importance of accurate nodal assessment. Sentinel lymph node biopsy (SLNB) has emerged as a minimally invasive alternative to systematic pelvic lymphadenectomy in early-stage disease, aiming to shorten operative time, reduce healthcare costs, and minimize treatment-related morbidity. This review synthesizes current evidence on SLNB in early-stage cervical cancer, including its diagnostic accuracy, optimal techniques, cost-effectiveness, and remaining clinical challenges. Data from prospective trials and meta-analyses demonstrate that SLNB provides high detection rates, especially with bilateral mapping and the use of advanced tracers such as indocyanine green. Ultrastaging further improves the detection of micrometastases and isolated tumor cells, refining adjuvant therapy decisions. Compared to full lymphadenectomy, SLNB significantly decreases intraoperative blood loss, operative time, and postoperative complications-most notably, lymphedema-while maintaining equivalent disease-free and overall survival. International guidelines now endorse SLNB for appropriately selected patients with early-stage cervical cancer (tumor size < 4 cm, negative preoperative imaging). However, variations persist between European and U.S. recommendations regarding its role as a standalone procedure. Future research must address protocol standardization, the prognostic relevance of low-volume metastases, and factors influencing mapping success. Overall, SLNB represents a paradigm shift toward more individualized, evidence-based surgical management of early-stage cervical cancer.