Introduction Investigate the utilization and outcomes of SLNBx algorithm for patients with cervical carcinoma.

Methods Patients diagnosed between 2012–2019 with cervical carcinoma who underwent hysterectomy with SLNBx or systematic lymphadenectomy (sLND) (defined as at least 10 LNs removed) were identified in the National Cancer Database. LN metastasis rates were calculated following stratification by tumor size. Overall survival (OS) was evaluated after controlling for confounders.

Results A total of 15711 patients were identified; 1710 (10.9%) had SLNBx. Utilization of SLNBx steadily increased from 2.7% in 2012 to 19.5% in 2019. Patient who had SLNBx were more likely to undergo simple hysterectomy (49.7% vs 44.5%, p<0.001), and minimally-invasive surgery (74.4% vs 56.3%, p<0.001). Rate of SLNBx was 12.8% for tumors <= 2 cm compared to 9% and 6.9% for those 2–4 and >4 cm, p<0.001. Rate of LN metastasis was comparable between the two groups for tumors <= 2 cm (6% vs 6.2%, p=0.83), 2–4 cm (20.9% vs 19.6%, p=0.54) and >4 cm (33.2% vs 28.3%, p=0.22). After controlling for mode and type of hysterectomy, SLNBx was associated with lower likelihood of prolonged hospital stay (OR 0.37, p<0.001). After controlling for confounders, SLNBx was not associated with worse OS for tumors <=2 cm (HR:1.0, 95% CI: 0.64, 1.55), 2–4 cm (HR 1.30, 95% CI: 0.89, 1.90), or > 4 cm (HR: 0.60, 95% CI: 0.34, 1.04).

Conclusion/Implications SLNBx is rapidly incorporated in the management of patients with cervical cancer with no detrimental effect on survival or detection rates of LN metastasis, and improved peri-operative outcomes.