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Use of a Sentinel Lymph Node Biopsy Algorithm in a South African Population of Patients With Cervical Cancer and High Prevalence of Human Immunodeficiency Virus Infection
  1. Leon Cornelius Snyman, MBChB, MPraxMed, MMed(O&G), FCOG(SA)*,
  2. Emma P. Bryant, FCOG(SA)*,
  3. Elize I. Wethmar, FCOG(SA)*,
  4. Tom de Greve, MD*,
  5. Florette Reyneke, MBChB,
  6. Mike M. Sathekge, PhD,
  7. Barend G. Lindeque, MD* and
  8. Nadeem R. Abu-Rustum, PhD,§
  1. *Gynaecologic Oncology Unit, Department of Obstetrics & Gynaecology, and
  2. Department of Obstetrics Nuclear Medicine, University of Pretoria, Pretoria, South Africa; and
  3. Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Centre; and
  4. §Department of Obstetrics and Gynaecology, Weill Cornell Medical College, New York, NY.
  1. Address correspondence and reprint requests to Leon Cornelius Snyman, MBChB, MPraxMed, MMed(O&G), FCOG(SA), University of Pretoria, PO Box 2092, Brooklyn Square, 0075, Pretoria, South Africa. E-mail: Leon.Snyman{at}


Objectives Cervical cancer is common in resource-poor settings with high prevalence of tuberculosis, pelvic inflammatory disease, and human immunodeficiency virus (HIV) infection. There are no data regarding the sentinel lymph node (SLN) algorithm in these high-risk cancer populations. Our objectives were to establish the sensitivity, specificity, positive predictive value, and negative predictive value of the SLN algorithm in cervical cancer and to compare the detection rate of indocyanine green (ICG) versus blue dye versus technetium Tc 99m nanocolloid (99mTc).

Methods This prospective study was conducted at the University of Pretoria. 99mTc-nanocolloid tracer, ICG dye, and methylene blue (MB) were used to detect SLNs. Pathological ultrastaging was performed on hematoxylin-eosin– negative nodes.

Results Results of 72 women were analyzed. The mean age was 47.2 years, 5.5% had a history of tuberculosis, 18.1% had pelvic inflammatory disease, and 65.3% were HIV positive. The SLN detection rate was 65.3%. Detection rate of MB was 56.9%; 99mTc, 69.4%; ICG, 87.5%; and the combination of MB and 99mTc, 91.7%. Pelvic nodal metastases occurred in 26.4%. The sensitivity, specificity, negative predictive value, and positive predictive value of SLN biopsy were 85.7%, 100%, 100%, and 98.33%, respectively. The false-negative rate was 14.3%, and it was 0% if the algorithm was applied.

Conclusions The SLN algorithm is a feasible option for use in cervical cancer women with a high prevalence of HIV infection. The detection rate is generally lower, but in select subgroups of women, it was comparable to that reported elsewhere. This is the first report of the use of SLN biopsy in a substantial group of HIV-infected women.

  • Cervical cancer
  • HIV infection
  • Sentinel lymph node biopsy algorithm
  • SLN

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  • N.R.A.-R. is supported in part by the National Institutes of Health/National Cancer Institute Memorial Sloan Kettering Cancer Center support grant P30 CA008748.

  • The authors declare no conflicts of interest.