Introduction To investigate the safety of sentinel node mapping for patients with early-stage cervical cancer undergoing cervical conization plus nodal evaluation.

Methods The ETERNITY project is a retrospective, multi-institutional study collecting data of patients with early-stage cervical cancer undergoing fertility-sparing treatment. Here, we compared outcomes related to three methods of nodal assessment: sentinel node mapping (SNM), SNM plus backup lymphadenectomy (SNM+LND); pelvic lymphadenectomy (LND)

Results Charts of 123 patients (with stage IA1-IB1 cervical cancer) were evaluated. Median patients’ age was 34 (range, 22 - 44) years. LND, SNM+LND, and SNM were performed in 60 (48.8%), 31 (25.2%), and 32 (26%) patients, respectively. Overall, eight (6.5%) patients were diagnosed with positive nodes. Two (3.3%), three (9.7%), and three (9.4%) patients were detected in patients who had LND, SNM+LND, and SNM respectively. Considering the 63 patients undergoing SNM (31 SNM+LND and 32 SNM alone). Macrometastases, micrometastases, and isolated tumor cells were detected in four (3.2%), three (2.4%), and one (0.8%) patients, respectively. All patients with positive nodes discontinued the fertility sparing treatment. Other two patients (one (1.7%) in the LND group and one (3.1%) in the SNM group) required hysterectomy even after negative nodal evaluation. After a median follow-up of 53.6 (range, 1.3, 158.0) months, nine (7.3%) and two (1.6%) patients developed local (i.e., cervical) and regional (i.e., pelvic lymph nodes) recurrences, respectively. Disease-free (p=0.332, log-rank test) and overall survival (p=0.769, log-rank test) were similar among groups.

Conclusion/Implications In this retrospective experience, SNM upholds long-term oncologic effectiveness of LND, reducing morbidity.