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A Prospective Single-Center Study of Sentinel Lymph Node Detection in Cervical Carcinoma: Is There a Place in Clinical Practice?
  1. Omer Devaja, MD, MSc, PhD, MRCOG*,
  2. Gautam Mehra, MRCOG*,
  3. Michael Coutts, MAFRC Path, FRCPA,
  4. Stephen Attard Montalto, MD, MRCOG*,
  5. John Donaldson, MA, MRCS, LRCP, FRCR,
  6. Mallikarjun Kodampur, MRCOG* and
  7. Andreas John Papadopoulos, MD, MRCOG*
  1. *Departments of Gynaecological Oncology,
  2. Departments of Histopathology, and
  3. Departments of Nuclear Medicine, Maidstone Hospital, Kent Oncology Centre, Maidstone, Kent, United Kingdom.
  1. Address correspondence and reprint requests to Omer Devaja, MD, MSc, PhD, MRCOG, Department of Gynaecological Oncology, Maidstone Hospital, Kent Oncology Centre, Maidstone, Kent, ME16 9QQ, United Kingdom. E-mail: o.devaja{at}nhs.net.

Abstract

Objective To establish the accuracy of sentinel lymph node (SLN) detection in early cervical cancer.

Materials and Methods Sentinel lymph node detection was performed prospectively over a 6-year period in 86 women undergoing surgery for cervical carcinoma by the combined method (Tc-99m and methylene blue dye). Further ultrastaging was performed on a subgroup of 26 patients who had benign SLNs on initial routine histological examination.

Results The SLN was detected in 84 (97.7%) of 86 women by the combined method. Blue dye uptake was not seen in 8 women (90.7%). Sentinel lymph nodes were detected bilaterally in 63 women (73.3%), and the external iliac region was the most common anatomic location (48.8%). The median SLN count was 3 nodes (range, 1–7). Of the 84 women with sentinel node detection, 65 also underwent bilateral pelvic lymph node dissection, and in none of these cases was a benign SLN associated with a malignant non-SLN (100% negative predictive value). The median non-SLN count for all patients was 19 nodes (range, 8–35). Eighteen patients underwent removal of the SLN without bilateral pelvic lymph node dissection. Nine women (10.5%) had positive lymph nodes on final histology. One patient had bulky pelvic nodes on preoperative imaging and underwent removal of the negative bulky malignant lymph nodes and a benign SLN on the contralateral side. This latter case confirms the unreliability of the SLN method with bulky nodes. The remaining 8 patients had positive SLNs with negative nonsentinel lymph nodes. Fifty-nine SLNs from 26 patients, which were benign on initial routine histology, underwent ultrastaging, but no further disease was identified. Four patients (5%) relapsed after a median follow-up of 28 months (range, 8–80 months).

Conclusion Sentinel lymph node detection is an accurate and safe method in the assessment of nodal status in early cervical carcinoma.

  • Cervical cancer
  • Sentinel lymph node
  • Ultrastaging
  • Immunohistochemistry

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Footnotes

  • The authors declare that there are no conflicts of interest.

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