Introduction/Background Sentinel node biopsy (SNB) with indocyanine green (ICG) is relatively new. More studies on distribution and involvement are required in any stage of cervical cancer.
Methodology 67 cervical cancer patients hospitalized within clinical study in University Clinical Center in Katowice between January 2021 and December 2022 were analyze. Out of them 33 were qualified for surgical interventions based on imagining and clinical evaluation – stage IA1-IB2, and IIA1. Laparoscopy with ICG cervical injection on 9 and 3 o’clock superficially and deeply (1.25 ml of 6.25 mg ICG, 25 mg in total) was performed to identify the sentinel nodes. All nodes were analyzed with hematoxylin-eosins staining and with ultrastaging.
Results Out of 33 patients qualified for the surgery, 66.7 women had squamous cell carcinoma, 30.3% - adenocarcinoma, and one adenosquamous carcinoma. In 4 cases SNB was a part of diagnostic procedure due to indecisive MRI images (3 cases) and fertility sparing procedure (one case). SNB in the last patients were negative (FIGO IA1), in 2 out of 3 with inconclusive MRI - positive (FIGO IIIC1) but in third metastasis were present in sigmoid (FIGO IVB). Out of the rest patients total 65 nodes were removed. Hematoxylin-Eosin staining revealed metastatic disease in 9 nodes (8 macrometastasis, one micrometastasis). Additionally, in ultrastaging 4 nodes with micrometastasis were identified. The concordance was 82.7%. Finally in 15 cases (51.7%) final stage was higher than suspected based on clinical examination and MRI images (9 women with IIIC1 and 6 with IIB).
Conclusion The proportion of advance stage cancer is very high what requires additional prevention strategies to decrease that numbers. As the prevalence of endocervical adenocarcinoma is high, Silva classification should be implemented to estimate survival prognosis and extent of treatment. Pre-operation work-up should be improve to properly identify patient with nodes and parametrial involvement.
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