Article Text

Download PDFPDF
Frozen section examination of sentinel lymph nodes can be used as a decisional tool in the surgical management of early cervical cancer
  1. A Rychlik1,
  2. MA Angeles2,
  3. F Migliorelli3,
  4. E Mery4,
  5. S Croce5,
  6. F Guyon1,
  7. G Ferron2,
  8. A Martinez2 and
  9. D Querleu1
  1. 1Department of Surgery, Institut Bergonié, Bordeaux
  2. 2Department of Surgery, Institut Claudius Regard, IUCT Oncopole, Toulouse, France
  3. 3Department of Obstetrics and Gynecology, Geneva University Hospitals, Geneva, Switzerland
  4. 4Department of Pathology, Institut Claudius Regard, IUCT Oncopole, Toulouse
  5. 5Department of Pathology, Institut Bergonié, Bordeaux, France


Introduction/Background The sentinel node procedure has been found to be accurate in detecting lymph node metastasis in early stage cervical cancer. The objective of this study is to evaluate the accuracy of frozen sections in the assessment of the sentinel node, with the objective to correctly orientate the intraoperative decision.

Methodology 176 patients with early stage cervical cancer undergoing sentinel lymph node (SLN) dissection with frozen section examination from two French Comprehensive Cancer Centers were included. A combined technique using isosulfan blue dye and technetium-99 was used in the majority of patients.

Results A total of 506 SLN were analyzed by frozen sections. Twenty-eight lymph nodes (5.5%) were positive at the time of definitive pathologic examination including 16 macrometastases, 9 micrometastases and 3 lymph nodes with isolated tumor cells. Three macrometastases, 2 micrometastases and 3 lymph nodes with isolated tumor cells were missed on frozen sections.

Bilateral mapping was detected in 153 (86.7%) out of 176 patients. Nineteen of these patients (12.4%) had SLN involvement including 3 patients with micrometastases and 3 patients with isolated tumor cells. Macrometastatic disease was identified at definitive pathology exam in 3 patients with negative frozen section analysis.Considering macrometastases only as positive lymph nodes, sensitivity of the frozen section was 76.9% (95% confidence interval 49.7–91.8) and negative predictive value was 97.9% (95% confidence interval 94.0–99.3). Including micrometastasis, sensitivity was 81.2% (95% confidence interval 57.0–93.4) and negative predictive value remained 97.9% (95% confidence interval 93.9–99.3).

Conclusion With a prevalence of positive lymph nodes on the order of 10%, the negative predictive value of frozen section examination of sentinel lymph nodes is 98%, with an inferior limit of the confidence interval superior to 94% in our series. Diagnostic accuracy remained acceptable even if micrometastases were included. Frozen section examination can be incorporated in the intraoperative decision algorithm.

Disclosure Nothing to disclose.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.