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Sentinel lymph node biopsy alone in the management of early cervical carcinoma
  1. Omer Devaja1,
  2. Andreas John Papadopoulos1,
  3. Rasiah Bharathan1,
  4. Stephen Attard Montalto1,
  5. Michael Coutts2,
  6. Alex Tan1,
  7. Alexis Corrigan3,
  8. Milica Perovic1 and
  9. Seyedeh Zahra Rezaei Lalami4
  1. 1Gynaecological Oncology, Maidstone Hospital, Maidstone, Kent, UK
  2. 2Histo Pathology, Maidstone, Kent, UK
  3. 3Nucler Medicine, Maidstone, Kent, UK
  4. 4Department of Mathematics and Applied Computation, University of Leicester, Leicester, Leicestershire, UK
  1. Correspondence to Professor Omer Devaja, -, Kent, UK; o.devaja{at}nhs.net

Abstract

Objective Sentinel lymph node (SLN) biopsy aims to assess lymph node status with reduced surgical morbidity. The aim of the study was to determine the accuracy and safety of SLN biopsy in the management of early cervical carcinoma using a double technique (technetium-99m (Tc-99m) nanocolloid and methylene blue dye injection).

Methods This was a 10-year study from January 2009 to January 2019 that recruited 103 consecutive women undergoing surgery for early cervical carcinoma, FIGO 2009 stage IA1 (grade 3, and grade 2 with lymphovascular space invasion) to IB1 (<2 cm), at the West Kent Gynaecological Oncology Centre, Maidstone, UK. All patients were given the choice of pelvic node dissection and SLN mapping or SLN only. All patients elected to undergo SLN only. In total 97 patients had SLN mapping performed laparoscopically. We used the combined method (Tc-99m nanocolloid and/or methylene blue dye). All SLN routinely underwent ultrastaging.

Results At least one SLN was detected in all 103 patients, using at least one of the combined methods (Tc-99m nanocolloid or blue dye). Bilaterally SLN were removed in 85/103 women with an 83% bilateral detection rate. The median SLN count was 2.3 (range 1–6) nodes. Of 103 patients, 7 (6.7%) patients had lymph node involvement. There were no pelvic or para-aortic lymph node recurrences with a median follow-up of 53 (range 8–120) months. The specificity and negative predictive value of a negative SLN was 100%. None of our 103 patients reported lower extremity lymphedema.

Conclusion In carefully selected patients with early cervical carcinoma, SLN biopsy alone appears to be a safe method for lymph node assessment of women undergoing surgical staging. Ultrastaging is an essential part of histologic examination of SLN.

  • SLN and lympadenectomy
  • cervix uteri
  • cervical cancer
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Footnotes

  • Contributors Omer Devaja - study design, drafting the manuscript, Andreas Papadopoulos drafting the manuscript, Rasiah Bharathan data collection, Stephen Montalto drafting the manuscript, Michael Curtis pathologist, Alex Tan data collection, Alexis Corrigan nuclear medicine spec CT reports, Milica Perovic data collection, Seyedeh Zahra Rezaei Lalami statistician

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Data form part of the hospital database.

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