Sentinel node identification in cervical cancer patients undergoing transperitoneal radical hysterectomy: a study of 100 cases

• Published in: International journal of gynecological cancer Vol. 16; no. 2; pp. 649 - 654
• Main Authors: Wydra, D, Sawicki, S, Wojtylak, S, Bandurski, T, Emerich, J
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.03.2006
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - secondary; Adenocarcinoma - surgery; Carcinoma, Adenosquamous - diagnostic imaging; Carcinoma, Adenosquamous - secondary; Carcinoma, Adenosquamous - surgery; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - secondary; Carcinoma, Squamous Cell - surgery; Cervical cancer; Feasibility Studies; Female; Humans; Hysterectomy; Intraoperative Care - methods; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Metastasis; Peritoneum - surgery; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Sentinel Lymph Node Biopsy; Technetium Tc 99m Aggregated Albumin; Tumors; Uterine Cervical Neoplasms - diagnostic imaging; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery
• ISSN: 1048-891X; 1525-1438
• DOI: 10.1136/ijgc-00009577-200603000-00030

We investigated the feasibility of sentinel lymph node (SN) identification using radioisotopic lymphatic mapping with technetium-99m-labeled nanocolloid and blue-dye injection in 100 patients with early cervical cancer (FIGO stage IB1 in 58, IB2 in 18, and IIA in 24) undergoing radical hysterectomy with pelvic lymphadenectomy. At least one SN was found in 84% on one side and in 66% on both sides. The sentinel detection rates according to the stages were as follows: 96.6% in IB1, 66.7% in IB2, and 62.5% in IIA with at least one SN on one side, and 86.2% in IB1, 38.9% in IB2, and 37.5% in IIA with at least one SN on both sides. Successful identification of at least one SN was less likely in patients with tumors >2 cm (54% of SN) compared with those with tumors </=2 cm (96% of SN). In 15/22 patients, the SNs were the only lymph nodes that were tumor positive. The false-negative rate for the SN procedure was 3% (3/100). In all false-negative SNs, the primary cervical tumor was above 2 cm and there was an isthmus infiltration. SN detection had 86.4% sensitivity (19/22), 100% specificity (66/66), and 95.5% negative predictive value (63/68). The sentinel node detection rate is relatively high and depends on the tumor size and FIGO stage.