Stellenwert der Sentinel-Lymphonodektomie beim Vulva- und Zervixkarzinom

Die Beurteilung der lymphatischen Metastasierung ist ein essenzieller Bestandteil des Stagings solider Tumoren. Mit der Sentinel-Lymphknoten-(SLN-)Biopsie steht ein minimalinvasives Verfahren zur Verfügung, dessen diagnostischer Stellenwert bei den Genitalkarzinomen unterschiedlich bewertet wird. Diese Übersichtsarbeit gründet sich auf einer leitlinienbasierten Literaturrecherche und berücksichtigt aktuelle Studien und Kongressbeiträge.

Kernaussagen

• Die Beurteilung der lymphatischen Metastasierung ist ein essenzieller Bestandteil des Stagings solider Tumoren.

• Jede 5. Frau mit Vulvakarzinom bzw. jede 4. mit Zervixkarzinom weist zum Zeitpunkt der Diagnosestellung bereits eine lymphatische Metastasierung auf [4].

• Mit der Sentinel-Lymphknoten-(SLN-)Biopsie steht ein minimalinvasives Verfahren zur Verfügung, das eine Einschätzung über den regionären Tumorbefall von Lymphknoten erlaubt und die Morbidität einer systematischen Lymphonodektomie verringert.

• Es weist zudem sozioökonomische Vorteile auf.

• Das SLN-Verfahren ist heute bereits beim Mammakarzinom und Malignen Melanom standardisiert und etabliert.

• Für selektierte Patientinnen mit Vulvakarzinom im Frühstadium gilt die SLN-Technik in Leitlinien als etabliert vor.

• Beim Zervixkarzinom zeigt sich das SLN-Verfahren bei Primärtumoren < 2 cm als günstig; es ist jedoch noch nicht ausreichend standardisiert. Weitere Studien laufen derzeit dazu.

• Die präoperative Lymphoszintigrafie stellt ein entscheidendes diagnostisches Instrumentarium dar, um SLN auch bei abweichenden anatomischen Verhältnissen zu detektieren und die Rate falsch negativer Befunde zu reduzieren [52].

• Künftige Leitlinien und aktuelle Studien werden genauer definieren müssen, welche Patientengruppen von der SLN-Technik in Diagnostik und Therapie profitieren können.

Schlüsselwörter

Zervixkarzinom - Vulvakarzinom - Sentinel-Lymphknoten - Ultrastaging - Mikrometastasen

Publication History

Article published online:
13 February 2024

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