Sentinel lymph node biopsy improves staging in early cervical cancer
Introduction
Sentinel lymph node (SLN) detection is widely used as a staging tool in cancer of the breast or vulva [1], [2] and has been suggested more recently in cancer of the cervix [3]. Many studies have established that SLN detection is feasible in patients with early-stage cervical cancer, especially with a laparoscopic approach [4]. When both a radioactive tracer and patent blue dye were used, SLNs were detected in over 85% of patients [5], [6], [7], [8], [9], [10]. In most studies, the mean number of SLNs per patient was two or greater, and the false-negative rate ranged from 0% to 5% [11], [12]. Morbidity rates have been extremely low [4], [5], [6], [7], [8], [9], [10].
The main goal of SLN detection is to improve nodal staging, which largely governs the prognosis of cervical cancer. SLN detection should improve lymphatic mapping in each individual patient by identifying nodes that are located outside the usual dissection field and that may lead to a recurrence if left in place in patients falsely considered as pN0 [13], [14]. SLN biopsy should also improve the detection of nodal micrometastases, which may influence the prognosis [15]. Micrometastasis detection requires sensitive techniques such as immunohistochemistry, which cannot be used on a large number of nodes [2], [16].
The primary objective of this study was to evaluate the contribution of SLN detection and biopsy to lymphatic mapping in patients with early cervical cancer. The secondary objective was to assess the micrometastasis rate. Finally, we sought to confirm the detection rate and negative predictive value (100%) found in our preliminary study [17].
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Patients and methods
We prospectively enrolled 25 patients with early cervical cancer (two FIGO stages Ia2, 20 stages Ib1 < 2 cm, and 3 patients who received pre-operative brachytherapy because cervical diameter was initially between 2 and 4 cm). Patients were operated on between January 1, 2003 and March 30, 2006. All histological types were eligible. We did not include patients with clinical parametrial involvement or preoperative imaging study findings consistent with nodal involvement. Neoadjuvant chemotherapy
Results
Mean age of the 25 patients was 51.2 ± 16.4 years (range, 30-85 years). Histology showed squamous cell carcinoma in 22 patients and adenocarcinoma in 3 patients. FIGO stage was Ia2 in 2 (8%) patients and Ib1 in 23 (92%). Lymphoscintigraphy was performed in 23 (92%) patients and endoscopic probe detection in 24 (96%) patients; thus, 2 patients did not undergo lymphoscintigraphy and 1 did not have the radioactive tracer injection, for reasons related to nuclear medicine department maintenance. Blue
Discussion
SLN detection and biopsy in patients with cervical cancer have been under study for more than 5 years [3]. This technique has proved feasible, including during laparoscopic surgery [17]. We investigated potential clinical benefits of SLN detection and biopsy in 25 patients with early-stage cervical cancer.
The mean number and the location of SLNs in our study were consistent with data in the literature. In keeping with previous studies [10], [11], [12], Marnitz et al. found a mean of 3.3 SLNs
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Clinical management of early-stage cervical cancer: The role of sentinel lymph node biopsy in tumors ≤2 cm
2019, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :A recent extensive review of the literature showed that, for early-stage cervical cancer patients (N = 1257) presenting tumor sizes <40 mm, bilateral negative SLNs after ultrastaging, and no other suspicious lymph nodes, the metastases risk is only 0.08% [22]. Bilateral ultrastaging of SLNs is a more reliable indicator of pelvic lymph node metastases than full pelvic lymphadenectomy, and also it is more cost-effective strategy with respect to 5-year progression-free survival and morbidity-free survival [23,24]. Ultrastaging of all SLNs in our study detected MIC in 2.3% of the patients; no ITCs were found.
Sentinel lymph node (SLN) concept in cervical cancer: Current limitations and unanswered questions
2019, Gynecologic OncologySLN biopsy in cervical cancer patients with tumors larger than 2 cm and 4 cm
2018, Gynecologic OncologyIndocyanine green and infrared fluorescence in detection of sentinel lymph nodes in endometrial and cervical cancer staging – a systematic review
2016, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :SLN biopsy has been proposed for patients with early cervical and endometrial carcinomas. Despite being a sensitive method for detecting lymph node involvement, it is still controversial [10,19]. In 2014, the National Comprehensive Cancer Network (NCCN) Endometrial Cancer Guidelines were updated to reflect the emerging data regarding the role of sentinel lymph node biopsy in endometrial cancer.
Detection of sentinel lymph node metastases in cervical cancer: Assessment of KRT19 mRNA in the one-step nucleic acid amplification (OSNA) method
2013, Gynecologic OncologyCitation Excerpt :Discordant cases were analyzed as shown in Table 3. With serial sectioning and IHC, SLN micrometastases have been detected in 1.7–20% of cervical cancer patients [2,11,23–30]. However, serial sectioning combined with IHC is difficult, time-consuming, and expensive, even if limited to SLNs.