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  • 2022-RA-908-ESGO The importance of pathological ultrastaging for sentinel lymph nodebiopsy in cervical cancer, the final outcome of the Sentix study (CEEGOG-CX01; ENGOT-CX2; NCT02494063)

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Cervical cancer
2022-RA-908-ESGO The importance of pathological ultrastaging for sentinel lymph nodebiopsy in cervical cancer, the final outcome of the Sentix study (CEEGOG-CX01; ENGOT-CX2; NCT02494063)
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  1. Roman Kocian1,
  2. Christhardt Koehler2,
  3. Sylva Bajsova3,
  4. Jiri Jarkovsky4,
  5. Ignacio Zapardiel5,
  6. Giampaolo Di Martino6,
  7. Luc van Lonkhuijzen7,
  8. Borek Sehnal8,
  9. Octavio Arencibia Sanchez9,
  10. Blanca Gil Ibanez10,
  11. Fabio Martinelli11,
  12. Jiri Presl12,
  13. Lubos Minar13,
  14. Radim Marek14,
  15. Peter Kascak15,
  16. Pavel Havelka16,
  17. Martin Michal17,
  18. Toon van Gorp18,
  19. Kristyna Nemejcova19 and
  20. David Cibula1
  1. 1Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, CEEGOG, Prague, Czech Republic
  2. 2Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, Hamburg, Germany
  3. 3Department of Obstetrics and Gynecology, University Hospital Ostrava, CEEGOG, Ostrava, Czech Republic
  4. 4Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
  5. 5Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
  6. 6Department of Obstetrics and Gynecology, Unit of Gynecologic Oncology Surgery, San Gerardo Hospital, Monza, Italy
  7. 7Center for Gynecologic Oncology, Academic Medical Centre, Amsterdam, Netherlands
  8. 8Department of Obstetrics and Gynecology, University Hospital Bulovka, First Faculty of Medicine, Charles University, CEEGOG, Prague, Czech Republic
  9. 9Department of Gynecologic Oncology, University Hospital of the Canary Islands, Las Palmas de Gran Canaria, Spain
  10. 10Unit of Gynecological Oncology, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona, Barcelona, Spain
  11. 11IRCCS Foundation National Cancer Institute in Milan, Milan, Italy
  12. 12Department of Gynaecology and Obstetrics, University Hospital Pilsen, Charles University, CEEGOG, Pilsen, Czech Republic
  13. 13Department of Gynecology and Obstetrics, Faculty of Medicine, Masaryk University, CEEGOG, Brno, Czech Republic
  14. 14Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc, CEEGOG, Olomouc, Czech Republic
  15. 15Department of Obstetrics and Gynecology, Faculty Hospital Trencin, CEEGOG, Trencin, Slovakia
  16. 16Department of Obstetrics and Gynecology, KNTB a.s, CEEGOG, Zlin, Czech Republic
  17. 17Department of Obstetrics and Gynaecology, Hospital Ceske Budejovice, JSC, CEEGOG, Ceske Budejovice, Czech Republic
  18. 18Department of Gynecology and Obstetrics, University Hospital Leuven, Leuven Cancer Institute, BGOG, Leuven, Belgium
  19. 19Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic

Abstract

Introduction/Background One of the advantages of sentinel lymph node (SLN) biopsy is the removal of only a small number of lymph nodes with the highest risk of involvement. Pathological SLN ultrastaging allows detection of metastases not identified during standard histological examination. Sentix is international prospective cohort study on SLN biopsy in cervical cancer with closed recruitment, which allowed to evaluate the importance of SLN ultrastaging and its intensity (examined levels) for the detection of N1.

Methodology Eligible stages: T1a1/L1 – T1b2 (<4 or ≤2 cm for fertility sparing), no suspicious lymph nodes on imaging, bilateral SLN detection. SLNs were intraoperatively examined by one section (standard assessment corresponding to the examination of non-SLN), and consequently processed by an intensive protocol for ultrastaging (paraffin blocks sectioned completely in 150–200 μm intervals; two sections from each level, stained with H&E and immunohistochemically). SLNs were submitted for central quality control.

Results Final cohort of 647 patients was analysed. Standard SLN examination revealed macrometastases (MAC), micrometastasis (MIC), and isolated tumour cells (ITC) in 36, 10, and 2 patients. Ultrastaging enabled to identify additional 7 cases with MAC, 29 MIC, 20 ITC. Of the 82 (12.7%) patients with positive SLN, only 46 (56.1%) cases were detected by standard assessment (83.7% MAC; 25.6% MIC). Additional N1 were identified by ultrastaging, 20 (24.4%) at level 1, 9 (11.0%) at levels 2–4, and 6 (7.3%) at level 5 or higher. There was no MAC beyond the first four levels.

Abstract 2022-RA-908-ESGO Figure 1
Abstract 2022-RA-908-ESGO Figure 1

Conclusion Pathological ultrastaging is a key component of the SLN concept in cervical cancer. It enables detection of additional 44% of patients with N1 (MAC, MIC) and almost all (91%) with ITC. The detection of positive SLN directly correlates with the intensity of ultrastaging. Four levels should become an international standard, which allows to detect over 90% of N1 (MAC, MIC).

https://doi.org/10.1136/ijgc-2022-ESGO.69

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