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Abstract
Introduction/Background The subsequent complications of pelvic-lymphadenectomy in patients with early-stage cervical-cancer, the sentinel-lymph-node (SLN) technique is increasingly used. Studies show that SLN-technique with methylene-blue alone is viable and adequate alternative to systematic-lymphadenectomy for early stage cervical cancer in selected patients.
Case Presentation A 30-years old patient who was diagnosed with cervical squamous cell carcinoma with a size of 2,1 cm, had no suspicious lymph node in the preoperative PET/CT and MRI scans. Thereupon, a fertility-sparing-trachelectomy operation was planned.
Results Sentinel-lymph-node evaluation and frozen-section were performed. Afterward micrometastases were detected during the frozen examination, the operation was terminated. Patient had no abnormal symptoms throughout early postoperative period. On the 3rd day after primary surgery patient was discharge without any further complication. After all pathology examination, the patient was accepted as FIGO2018 Stage 3C1 and referred to chemoradiotherapy.
Conclusion Many published studies show the feasibility of SLNB for cervical-cancer. The latest edition of the National-Comprehensive-Cancer-Network (NCCN) Practice Guide says sentinel lymph node dissection can only be used in stage I patients and patients with tumor size <4 cm, but is best for tumor <2 cm. There is ample evidence that SLN without systematic lymph node resection has the same oncology outcomes and fewer complications.According to Yahta et al. investigated surgical complications and prognostic outcomes in patients with early stage cervical-cancer who underwent SLN for trachelectomy or hysterectomy found that operative-time, lymphedema, lymphangitis, and blood-loss were significantly lower in patients with SLN compared to patients who underwent systemic pelvic lymphadenectomy, and the prognostic outcomes were not different between the two groups. In developing-countries, all necessary dyes for sentinel-lymph-nodes are not available in all centers. Our case is very significant in terms of showing that sentinel-lymph-node can be detected and metastasis can be detected with methylene-blue alone, with right technique and surgical management.