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Prospective Study of Sentinel Lymph Node Biopsy Without Further Pelvic Lymphadenectomy in Patients With Sentinel Lymph Node–Negative Cervical Cancer
  1. Hitoshi Niikura, MD*,
  2. Satoshi Okamoto, MD*,
  3. Takeo Otsuki, MD*,
  4. Kosuke Yoshinaga, MD*,
  5. Hiroki Utsunomiya, MD*,
  6. Satoru Nagase, MD*,
  7. Tadao Takano, MD*,
  8. Kiyoshi Ito, MD*,
  9. Mika Watanabe, MD and
  10. Nobuo Yaegashi, MD*
  1. *Departments of Obstetrics and Gynecology and
  2. Departments of Pathology, Tohoku University School of Medicine, Sendai, Japan.
  1. Address correspondence and reprint requests to Hitoshi Niikura, MD, Tohoku University Graduate School of Medicine, Sendai, Japan. E-mail: niikura{at}


Objective The aim of the present study was to evaluate the incidence of lymphedema and cancer recurrence rate in patients with cervical cancer who undergo sentinel lymph node (SLN) biopsy alone in the absence of SLN metastases.

Patients and Methods The study included 35 consecutive patients with cervical cancer scheduled for radical hysterectomy at Tohoku University Hospital between May 2006 and July 2009. All patients had International Federation of Gynecology and Obstetrics stages IA1 to IIA1 disease. Patients in whom SLNs were detected unilaterally or not detected and/or whose lymph nodes were diagnosed intraoperatively as positive metastasis underwent systemic pelvic lymphadenectomy. Patients who were found negative for SLN metastasis did not undergo further pelvic lymphadenectomy.

Results The mean number of detected SLNs was 4.1 (range, 1–11). True lymph node metastasis could be detected in 11 (31%) of the 35 cases. Intraoperative frozen section identified correctly in 8 of 11 metastatic patients. Twenty-three patients underwent SLN biopsy alone without systematic pelvic lymphadenectomy. None of the 23 patients diagnosed with negative SLNs have experienced a lymph node recurrence in the pelvic cavity. New symptomatic lower extremity lymphedema was identified in 2 (8.7%) of the 23 patients who underwent SLN biopsy alone and in 5 (42%) of 12 patients who underwent systematic lymphadenectomy.

Conclusion Radical hysterectomy with SLN biopsy alone seems to be a safe and effective strategy for detection of lymph node metastasis and for reducing the number of patients with lower extremity lymphedema, but a more convenient and sensitive procedure for intraoperative diagnosis needs to be established.

  • Sentinel lymph node (SLN)
  • Cervical cancer
  • 99mTc phytate
  • Micrometastasis
  • Lymphedema

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  • This work was supported by a Grant-in-Aid from the Kurokawa Cancer Research Foundation; a Grant-in-Aid for Scientific Research on Priority Areas from the Ministry of Education, Science and Culture, Japan; a Grant-in-Aid from the Ministry of Health, Labor and Welfare, Japan; and the 21st Century COE Program Special Research Grant (Tohoku University) from the Ministry of Education Science, Sports and Culture, Japan.

  • The authors declare no conflicts of interest.