Introduction/Background*Sentinel lymph node (SLN) mapping is routinely used in many centres to evaluate the lymph node status of women with cervical cancer and small volume disease. However, there is limited evidence regarding the accuracy of SLN mapping for larger cervical tumours. In a national multicentre setting, we evaluated the SLN detection rate and incidence of nodal disease in women with early-stage cervical cancer and investigated the accuracy of SLN mapping and FDG-PET/CT in tumours >20 mm.
Methodology We prospectively included women with early-stage cervical cancer from March 2017-January 2021 to undergo SLN mapping. Women with tumours >20 mm underwent completion pelvic lymphadenectomy and removal of FDG-PET/CT positive nodes. We followed an SLN algorithm with ultrastaging of all SLNs, removal of clinically suspicious lymph nodes and hemi- or full pelvic lymphadenectomy in cases of failed SLN mapping. We determined SLN detection rates, incidence of nodal disease, sensitivity and negative predictive value (NPV) of SLN mapping, and the sensitivity, specificity, NPV, and positive predictive value (PPV) of FDG-PET/CT.
Result(s)*We included 245 women, and 38 (15.5%) had nodal metastasis. The SLN detection rate was 96.3% (236/245), with 82.0% (201/245) bilateral detection. In a stratified analysis of 103 women with tumours >20 mm, 27 (26.2%) had nodal metastases. The sensitivity of SLN mapping adhering to the algorithm was 96.3% (95% CI 81.0-99.9%) and the NPV 98.7% (95% CI 93.0-100%). For FDG-PET/CT imaging the sensitivity was 14.8% (95% CI 4.2-33.7%), the specificity 85.5% (95% CI 75.6-92.5%), the NPV 73.9% (95% CI 63.4-82.7%), and the PPV 26.7% (95% CI 7.8-55.1%).
Conclusion*Our results suggest that SLN mapping is a reliable method in women with early-stage cervical cancer when adhering to an SLN algorithm. However, until the oncological safety is established, we recommend completion pelvic lymphadenectomy in women with tumours >20 mm. The use of FDG-PET/CT for nodal staging in women with early-stage cervical cancer should be re-evaluated.
Statistics from Altmetric.com
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.