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The efficacy of an algorithm using sentinel lymph node biopsy and frozen section in the avoidance of a combined treatment in early-stage cervical cancer management
  1. L Dostalek1,
  2. J Slama1,
  3. D Fischerova1,
  4. R Kocian1,
  5. A Germanova1,
  6. F Fruhauf1,
  7. K Nemejcova2,
  8. P Dundr2,
  9. J Jarkovsky3 and
  10. D Cibula1
  1. 1Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague
  2. 2Department of Pathology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague
  3. 3Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic


Introduction/Background The need for a combined treatment composed of radical surgery followed by adjuvant radiotherapy can be decreased by abandoning radical surgery in patients with intraoperatively detected lymph node (LN) involvement. The aim of the study was to analyze efficacy of the algorithm using intraoperative pathological assessment of sentinel LN (SLN).

Methodology Cervical cancer patients were included into the study who had stage T1a - T2b squamous, adeno- or adenosquamous carcinoma, were referred for primary surgical treatment, and had at least one SLN detected and submitted for frozen section evaluation. In the case of intraoperatively detected SLN involvement, parametrectomy (radical hysterectomy or trachelectomy) was abandoned and the patient was referred for primary chemoradiation. Radical surgery was completed in patients with intraoperatively negative SLNs. Indications for postoperative adjuvant radiotherapy included LN involvement from final pathology, parametrial involvement, or positive resection margins.

Results The trial included 309 patients (table 1). LN positivity was intraoperatively detected in 18 (6%) patients in whom radical hysterectomy was abandoned. Adjuvant radiotherapy after completed radical surgery was given to 29 (9%) cases, including 20 cases with macrometastases (MAC; 8) or micrometastases (MIC; 12) reported from the final histology, 8 cases with positive parametria (all ≤ 3 mm), and 1 case with a positive vaginal resection margin (figure 1).

Abstract – Table 1

Demographic data

Abstract – Figure 1

Flowchart of patients with early stage cervical cancer (2005–2015)

SLN - sentinel lymph node; MAC - macrometastasis (≥ 2mm); MIC - micrometastasis (0.2 – 2 mm); ITC - isolated tumor cells (<0.2mm)

Conclusion Out of 47 (15%) patients with high-risk prognostic risk factors (LN, parametria or surgical margin involvement), in only 19 (38%) of them was a combined treatment successfully avoided. This was due to the low sensitivity of frozen section in the detection of MIC and low accuracy of clinical staging in the detection of microscopic parametrial involvement.

Disclosure Nothing to disclose.

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