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Pre-operative surgical algorithm: sentinel lymph node biopsy as predictor of parametrial involvement in early-stage cervical cancer
  1. Vincent Balaya1,2,
  2. Arnaud Bresset3,
  3. Benedetta Guani1,2,
  4. Louise Benoit4,
  5. Laurent Magaud5,
  6. Hélène Bonsang-Kitzis6,
  7. Charlotte Ngo6,
  8. Patrice Mathevet1,2 and
  9. Fabrice Lécuru7 SENTICOL group
  1. 1 Gynecology Department, University Hospital of Lausanne Department of Gynaecology and Paediatrics, Lausanne, Vaud, Switzerland
  2. 2 University of Lausanne, Lausanne, Switzerland
  3. 3 Obstetrics and Gynecology department, Beaujon Hospital, Clichy, France
  4. 4 Surgical Oncology Department, Curie Institute, St-Cloud, France
  5. 5 Public Health Department, Civil Hospices of Lyon, Lyon, Auvergne-Rhône-Alpes, France
  6. 6 Gynecologic and Breast Surgery Center, Groupe Ramsay hôpital des Peupliers, Paris, France
  7. 7 Breast, Gynecology and Reconstructive Surgery Unit, Institute Curie, Paris, France
  1. Correspondence to Dr Vincent Balaya, Gynecology Department, University Hospital of Lausanne Department of Gynaecology and Paediatrics, Lausanne, Switzerland; vbalaya{at}hotmail.com

Abstract

Introduction Radical hysterectomy is the gold standard in the management of early-stage cervical cancer. Parametrectomy aims to remove occult disease but is associated with significant surgical morbidity. Avoiding unnecessary parametrectomy in a subset of patients at low risk of parametrial involvement may decrease the incidence of such morbidity. The purpose of this study was to identify patients at low risk of parametrial involvement in early-stage cervical cancer potentially eligible for less radical surgery based on pre-operative criteria and sentinel lymph node (SLN) status.

Methods We performed an ancillary analysis of data from two prospective trials on sentinel node biopsy for cervical cancer (SENTICOL I and II). Patients with International Federation of Gynecology and Obstetrics (FIGO) IA–IIA cervical cancer who underwent primary radical surgery and bilateral SLN mapping were identified between 2005 and 2012 from 25 French oncologic centers. Patients who underwent pre-operative brachytherapy or did not undergo radical surgery (simple trachelectomy, simple hysterectomy, or lymph node staging only) were excluded.

Results Of 174 patients who fullfiled the inclusion criteria, 9 patients (5.2%) had parametrial involvement and 24 patients (13.8%) had positive SLN. Most patients had 2018 FIGO stage IB1 disease (86.1%) and squamous cell carcinomas (68.9%). Parametrial involvement was significantly associated with tumor size ≥20 mm on pelvic magnetic resonance imaging (MRI) (adjusted odds ratio (ORa) 9.30, 95% CI 1.71 to 50.57, p=0.01) and micrometastic or macrometastatic SLN (ORa 8.98, 95% CI 1.59 to 50.84, p=0.01). Of 114 patients with tumors <20 mm on pre-operative MRI and negative SLN after ultrastaging, only one patient had parametrial involvement (0.9%). By triaging patients with both of these criteria in a two-step surgical procedure, unjustified and contra-indicated radical hysterectomy would have been avoided in 65.5% and 8.6% of cases, respectively.

Conclusions Less radical surgery may be an option for patients with bilateral negative SLN after ultrastaging and tumors <20 mm. SLN status should be integrated into the decision-making process for tailored surgery in early-stage cervical cancer.

  • cervical cancer
  • gynecologic surgical procedures
  • sentinel lymph node
  • surgical oncology
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Footnotes

  • Twitter @BenedettaGuani

  • Collaborators SENTICOL group.

  • Contributors Study concepts: VB, BG, PM, FL. Study design: VB, AB, PM, FL. Data acquisition: LM, PM, FL, VB, AB. Quality control of data and algorithms: LM, FL, PM, BG, VB. Data analysis and interpretation: VB, FL, LB, HB-K, CN, AB. Statistical analysis: LB, HB-K, VB, BG. Manuscript preparation: VB, AB, FL, PM. Manuscript editing: VB, FL, CN, HB-K, BG. Manuscript review: FL, PM, BG.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information.

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