Introduction/Background Lymph node (LN) metastasis is one of the most important prognostic factors of survival among women with cervical cancer (CC). Since October 2018 LN status has become part of the International Federation of Gynaecology and Obstetrics (FIGO) staging.
Benefits of sentinel lymph node (SLN) biopsy include avoidance of morbidity from pelvic lymphadenectomy, and increased detection rate of LN metastases through ultrastaging and removal of SLN in uncommon locations that are not typically included in a standard lymphadenectomy.
Methodology A retrospective analysis of patients with CC undergoing laparoscopic SLN mapping and frozen section (FS) of SLN biopsy followed by radical hysterectomy or pelvic and/or para-aortic lymphadenectomy, according to the results of the SLN biopsy.
Hybrid technique with indocyanine green ICG-99mTc nanocoloid was used.
Results From the introduction of SLN biopsy at our centre in July 2018 to May 2019, 7 patients with clinical FIGO stage IB1/IB2/IIA1 CC underwent SLN detection. Of these, one patient had unilateral SLN detection, while the 6 remaining patients had a bilateral identification of SLN.
Positive SLN was found in 2 patients in the FS analysis. In one case, with negative computed tomography (CT) of pelvic and para-aortic LN involvement, the SLN drained directly into the inframesenteric para-aortic area, and was positive for malignancy. In the other case, the SLN was located by the external left iliac vein.
These 2 patients were upstaged to IIIC1 and IIIC2 and could correctly be triaged to definitive chemoradiotherapy, abandoning radical hysterectomy.
Conclusion The combination of SLN mapping with hybrid tracer (ICG-99mTc nanocoloid) and FS seems to have the potential to improve the disease stage with lower morbidity, offering an efficient tool in triaging patients to definitive chemo-radiotherapy. SLN biopsy could upstage patients with presumed early stage cervical cancer and avoid combining radical surgery and chemoradiotherapy due to the high morbidity after combined treatment.
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