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Cancers
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Lymph Node Dissection for Gynecologic Cancers
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Lymph Node Dissection for Gynecologic Cancers

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Methods and Technologies Development".

Deadline for manuscript submissions: 31 December 2025 | Viewed by 9036

Special Issue Editor

Dr. Fabio Landoni

E-Mail Website
Guest Editor
Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, 20900 Monza, Italy
Interests: ovarian cancer; oncology; surgery; gynecologic oncology; gynaecological surgery; hysterectomy; cancer prevention; laparoscopic surgery; gynecologic surgical procedures; pelvic reconstructive surgery

Special Issue Information

Dear Colleagues,

In this Special Issue, we will focus on the role of lymph node dissection (either sentinel lymph node or lymphadenectomy) for gynecological cancers.

In vulvar, endometrial, and cervical cancer, sentinel lymph node (SLN) mapping is becoming increasingly popular and is finding its application in everyday surgical practice. However, this is opening many new unanswered questions. The innovations in technique and the attempt to standardize it, the oncological meaning of isolated tumor cells and low-volume metastasis, the role of completion lymphadenectomy in positive sentinel lymph node cases, the possible use of sentinel node in fertility-sparing procedures, and, in general, the oncological safety of the SLN procedure are just some of the challenges we are facing in this new era.

Lymph node dissection has been recently tested in advanced-stage epithelial ovarian cancers. However, its role is still debated in early-stage epithelial and some non-epithelial ovarian cancers. The possible therapeutic benefit of lymphadenectomy is controversial, but it plays a role in staging, helping the clinician decide on adjuvant treatment. Recent studies suggest SLN as a possible procedure, but it is still experimental.

Additionally, the significant advances in imaging and molecular techniques are, in general, challenging this surgical procedure's role and helping in tailoring surgical and adjuvant treatment.

This Special Issue aims to give an up-to-date point of view on the role of lymph node dissection (either sentinel lymph node or lymphadenectomy) in treating all gynecological cancers in all settings (from fertility-sparing to radical surgery). We hope it will help in defying and stratifying the patients who will or will not benefit from this procedure. We also hope that it will give readers information about the impact of lymph node dissection on morbidities and patient-related outcomes, the choice of adjuvant treatments, and the diffusion of the different approaches in different healthcare systems.

Therefore, we are pleased to invite you to submit your original research or review articles for this Special Issue.

Research areas may include (but are not limited to) the following:

  • Vulvar cancer; vaginal cancer; cervical cancer; endometrial cancer; epithelial ovarian cancer; non-epithelial ovarian cancer; rare gynecological cancers.
  • Lymphadenectomy; sentinel lymph node; surgical technique.
  • Low volume metastasis (Isolated tumor cells and/or micrometastasis); Positive nodes in general.  
  • Imaging, molecular, clinical data to define patients who will benefit or not from lymph node dissection.
  • Role of lymph node dissection in the choice of adjuvant treatment.
  • Role of lymph node dissection in fertility-sparing treatments.
  • Role of lymph node dissection at the time of recurrence.

We look forward to receiving your contributions.

Dr. Fabio Landoni 
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (5 papers)

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Research

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13 pages, 1056 KB  
Article
Diagnostic Accuracy and Interrater Agreement of FDG-PET/CT Lymph Node Staging in High-Risk Endometrial Cancer: The SENTIREC-Endo Study
by Jorun Holm, André Henrique Dias, Oke Gerke, Annika Loft, Kirsten Bouchelouche, Mie Holm Vilstrup, Sarah Marie Bjørnholt, Sara Elisabeth Sponholtz, Kirsten Marie Jochumsen, Malene Grubbe Hildebrandt and Pernille Tine Jensen
Cancers 2025, 17(14), 2396; https://doi.org/10.3390/cancers17142396 - 19 Jul 2025
Viewed by 620
Abstract
Background/Objectives: The SENTIREC-endo study identified a safe sentinel lymph node mapping algorithm combined with PET-positive node dissection, matching radical pelvic and paraaortic lymphadenectomy in high-risk endometrial cancer. The present study evaluated the diagnostic accuracy of FDG-PET/CT for lymph node metastases in the same [...] Read more.
Background/Objectives: The SENTIREC-endo study identified a safe sentinel lymph node mapping algorithm combined with PET-positive node dissection, matching radical pelvic and paraaortic lymphadenectomy in high-risk endometrial cancer. The present study evaluated the diagnostic accuracy of FDG-PET/CT for lymph node metastases in the same population based on location, size, and Standardised Uptake Value (SUV), in addition to assessing interrater agreement across three Danish centres. Methods: This prospective multicentre study included women with high-risk endometrial cancer from the Danish SENTIREC study database (2017–2023). All patients underwent preoperative FDG-PET/CT. Diagnostic accuracy was evaluated against a pathology-confirmed reference standard. Interrater agreement was evaluated between trained specialists in Nuclear Medicine. Results: Among 227 patients, 52 patients (23%) had lymph node metastases. FDG-PET/CT identified lymph node metastases with 56% sensitivity (95% CI: 42–68) and 91% specificity (95% CI: 86–94). Positive and negative predictive values were 64% and 87%, respectively. Specificity for paraaortic nodes was high (97%), though sensitivity remained limited (56%). Lymph node size and SUVmax had moderate diagnostic value (AUC-ROC ~0.7). Interrater proportion of agreement was 95% and Cohen’s Kappa κ = 0.84 (95% CI: 0.73–0.94), the latter of which was ‘almost perfect’. Conclusions: FDG-PET/CT had limited sensitivity in lymph node staging in high-risk EC, and the diagnostic accuracy of FDG-PET/CT remains complementary to the sentinel node procedure. Due to its high specificity and strong interrater reliability, FDG-PET/CT is recommended for clinical implementation in combination with the sensitive sentinel node biopsy for the targeted dissection of PET-positive lymph nodes, particularly in paraaortic regions. Full article
(This article belongs to the Special Issue Lymph Node Dissection for Gynecologic Cancers)
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21 pages, 18499 KB  
Article
Impact of a Surgical Approach on Endometrial Cancer Survival According to ESMO/ESGO Risk Classification: A Retrospective Multicenter Study in the Northern Italian Region
by Vincenzo Dario Mandato, Anna Myriam Perrone, Debora Pirillo, Gino Ciarlini, Gianluca Annunziata, Alessandro Arena, Carlo Alboni, Ilaria Di Monte, Vito Andrea Capozzi, Andrea Amadori, Ruby Martinello, Federica Rosati, Marco Stefanetti, Andrea Palicelli, Giacomo Santandrea, Renato Seracchioli, Roberto Berretta, Lorenzo Aguzzoli, Federica Torricelli and Pierandrea De Iaco
Cancers 2025, 17(13), 2261; https://doi.org/10.3390/cancers17132261 - 7 Jul 2025
Viewed by 799
Abstract
Background: Following the results of the Laparoscopic Approach to Carcinoma of the Cervix (LACC) trial, doubts have arisen about the safety of laparoscopy in the treatment of endometrial cancer. Methods: A retrospective multicenter cohort study which included all endometrial cancer (EC) patients [...] Read more.
Background: Following the results of the Laparoscopic Approach to Carcinoma of the Cervix (LACC) trial, doubts have arisen about the safety of laparoscopy in the treatment of endometrial cancer. Methods: A retrospective multicenter cohort study which included all endometrial cancer (EC) patients who underwent a hysterectomy in Emilia Romagna hospitals from 2000 to 2019. All cases were revised and classified according to the 2009 International Federation of Gynaecology and Obstetrics (FIGO) staging system. The different impacts of the surgical approach on survival were stratified according to the recurrence risk from the 2016 European Society for Medical Oncology (ESMO)–European Society of Gynaecological Oncology (ESGO) classification system. The clinical characteristics and oncological outcome of patients treated by laparoscopy were compared with those treated by laparotomy. Results: A total of 2402 EC patients were included in the study. The use of laparoscopy has increased over the years, reaching 81% of procedures in 2019. Laparoscopy reduced complications and hospital stay. Laparoscopy was preferred to treat low, intermediate, and intermediate/high-risk patients. Laparoscopy showed no adverse effects on overall survival (OS) in any recurrence risk class. Particularly in high-risk EC patients, laparoscopy was associated with an increased OS in comparison with women treated by laparotomy regardless of the use of adjuvant therapy. Conclusions: Laparoscopy should always be chosen to treat EC of any risk class. The goal is to ensure correct treatment and oncological safety regardless of the surgical approach. Full article
(This article belongs to the Special Issue Lymph Node Dissection for Gynecologic Cancers)
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14 pages, 772 KB  
Article
Uterine Carcinosarcoma—A Retrospective Cohort Analysis from a Tertiary Centre on Epidemiology, Management Approach, Outcomes and Survival Patterns
by Sarah Louise Smyth, Katherine Ripullone, Andreas Zouridis, Christina Pappa, Geraldine Spain, Aikaterina Gkorila, Amika McCulloch, Phoebe Tupper, Farhat Bibi, Negin Sadeghi, Alisha Sattar, Shmaila Siddiki, Susan Addley, Mostafa Abdalla, Federico Ferrari, Stephen Damato, Sean Kehoe and Hooman Soleymani majd
Cancers 2025, 17(4), 635; https://doi.org/10.3390/cancers17040635 - 14 Feb 2025
Cited by 2 | Viewed by 1302
Abstract
Background/Objectives: Uterine carcinosarcoma (UCS) refers to a rare high-grade aggressive epithelial non-endometrioid endometrial carcinoma, with tumour cells demonstrating epithelial–mesenchymal metaplastic transition and composed of both carcinomatous epithelial and sarcomatous (homologous or heterologous) components. Methods: The aim of this study was to evaluate the [...] Read more.
Background/Objectives: Uterine carcinosarcoma (UCS) refers to a rare high-grade aggressive epithelial non-endometrioid endometrial carcinoma, with tumour cells demonstrating epithelial–mesenchymal metaplastic transition and composed of both carcinomatous epithelial and sarcomatous (homologous or heterologous) components. Methods: The aim of this study was to evaluate the epidemiology, management approach, outcomes and survival patterns of patients with UCS. Seventy-seven cases of UCS treated with primary surgery in a single tertiary centre underwent retrospective cohort analysis across a ten-year period. Observational data on clinicopathological variables and treatment pathways were reviewed and independent risk factors for relapse and mortality were analysed. Results: The 5-year disease-free and overall survival rates were 52.10% and 46.6%, respectively. Cervical stromal involvement was independently related to disease-free survival (HR = 6.26; 95%CI 1.82–21.59; p = 0.004) and overall survival (HR = 3.64; 95%CI 1.42–9.38; p = 0.007), whilst sarcomatous component type was independently related to recurrence only (HR = 3.62; 95%CI 1.38–9.51; p = 0.009) after adjusting for other pathological and treatment variables. No significant difference in recurrence or mortality was found when comparing the performance of pelvic lymph node dissection (p = 0.803 and p = 0.192 respectively) or the administration of adjuvant treatment (p = 0.546 and p = 0.627 respectively). Conclusions: Whilst our data suggests an encouraging similarity in overall survival rates compared with the literature, UCS continues to represent significant treatment challenges—with a paucity of guidelines available. Data regarding molecular analysis was not systemically available in our cohort, the more recent introduction of which (alongside the revision of endometrial cancer staging) will undoubtedly provide UCS patients with improved therapeutic options in the future. Full article
(This article belongs to the Special Issue Lymph Node Dissection for Gynecologic Cancers)
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Review

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17 pages, 873 KB  
Review
Low-Volume Metastases in Apparent Early-Stage Endometrial Cancer: Prevalence, Clinical Significance, and Future Perspectives
by Diletta Fumagalli, Luigi A. De Vitis, Giuseppe Caruso, Tommaso Occhiali, Emilia Palmieri, Benedetto E. Guillot, Giulia Pappalettera, Carrie L. Langstraat, Gretchen E. Glaser, Evelyn A. Reynolds, Robert Fruscio, Fabio Landoni, Andrea Mariani and Tommaso Grassi
Cancers 2024, 16(7), 1338; https://doi.org/10.3390/cancers16071338 - 29 Mar 2024
Cited by 9 | Viewed by 2656
Abstract
Endometrial cancer (EC) is the most diagnosed gynecologic malignancy, and its incidence and mortality are increasing. The prognosis is highly dependent on the disease spread. Surgical staging includes retroperitoneal evaluation to detect potential lymph node metastases. In recent years, systematic lymphadenectomy has been [...] Read more.
Endometrial cancer (EC) is the most diagnosed gynecologic malignancy, and its incidence and mortality are increasing. The prognosis is highly dependent on the disease spread. Surgical staging includes retroperitoneal evaluation to detect potential lymph node metastases. In recent years, systematic lymphadenectomy has been replaced by sentinel lymph node (SLN) biopsy and ultrastaging, allowing for the detection of macrometastases, micrometastases, and isolated tumor cells (ITCs). Micrometastases and ITCs have been grouped as low-volume metastases (LVM). The reported prevalence of LVM in studies enrolling more than one thousand patients with apparent early-stage EC ranges from 1.9% to 10.2%. Different rates of LVM are observed when patients are stratified according to disease characteristics and their risk of recurrence. Patients with EC at low risk for recurrence have low rates of LVM, while intermediate- and high-risk patients have a higher likelihood of being diagnosed with nodal metastases, including LVM. Macro- and micrometastases increase the risk of recurrence and cause upstaging, while the clinical significance of ITCs is still uncertain. A recent meta-analysis found that patients with LVM have a higher relative risk of recurrence [1.34 (95% CI: 1.07–1.67)], regardless of adjuvant treatment. In a retrospective study on patients with low-risk EC and no adjuvant treatment, those with ITCs had worse recurrence-free survival compared to node-negative patients (85.1%; CI 95% 73.8–98.2 versus 90.2%; CI 95% 84.9–95.8). However, a difference was no longer observed after the exclusion of cases with lymphovascular space invasion. There is no consensus on adjuvant treatment in ITC patients at otherwise low risk, and their recurrence rate is low. Multi-institutional, prospective studies are warranted to evaluate the clinical significance of ITCs in low-risk patients. Further stratification of patients, considering histopathological and molecular features of the disease, may clarify the role of LVM and especially ITCs in specific contexts. Full article
(This article belongs to the Special Issue Lymph Node Dissection for Gynecologic Cancers)
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12 pages, 761 KB  
Review
Low-Volume Metastases in Cervical Cancer: Does Size Matter?
by Tommaso Bianchi, Tommaso Grassi, Giampaolo Di Martino, Serena Negri, Gaetano Trezzi, Robert Fruscio and Fabio Landoni
Cancers 2024, 16(6), 1107; https://doi.org/10.3390/cancers16061107 - 9 Mar 2024
Cited by 3 | Viewed by 2575
Abstract
The implementation of sentinel lymph node (SLN) biopsy is changing the scenario in the surgical treatment of early-stage cervical cancer, and the oncologic safety of replacing bilateral pelvic lymphadenectomy with SLN biopsy is currently under investigation. Part of the undisputed value of SLN [...] Read more.
The implementation of sentinel lymph node (SLN) biopsy is changing the scenario in the surgical treatment of early-stage cervical cancer, and the oncologic safety of replacing bilateral pelvic lymphadenectomy with SLN biopsy is currently under investigation. Part of the undisputed value of SLN biopsy is its diagnostic accuracy in detecting low-volume metastases (LVM) via pathologic ultrastaging. In early-stage cervical cancer, the reported incidence of LVM ranges from 4 to 20%. The prognostic impact and the role of adjuvant treatment in patients with LVM is still unclear. Some non-prespecified analyses in prospective studies showed no impact on the oncologic outcomes compared to node-negative disease. However, the heterogeneity of the studies, the differences in the disease stage and the use of adjuvant treatment, and the concomitant pelvic lymphadenectomy (PLND) make reaching any conclusions on this topic hard. Current guidelines suggest considering micrometastases (MIC) as a node-positive disease, while considering isolated tumor cells (ITC) as a node-negative disease with a low level of evidence. This review aims to highlight the unanswered questions about the definition, identification, and prognostic and therapeutic roles of LVM and to underline the present and future challenges we are facing. We hope that this review will guide further research, giving robust evidence on LVM and their impacts on clinical practice. Full article
(This article belongs to the Special Issue Lymph Node Dissection for Gynecologic Cancers)
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