Abstract
Objective
To evaluate the experience with sentinel lymph node (SLN) biopsy in patients with
early-stage cervical cancer at our hospital, and to analyze factors influencing the
rate of false negatives.
Study design
This study was carried out at the Vall d’Hebron Hospital (Barcelona, Spain) between
September 2000 and October 2016. All patients underwent SLN biopsy and systematic
and bilateral pelvic lymphadenectomy, followed by radical hysterectomy. SLNs were
analyzed by the pathologist by staining with hematoxylin-eosin and immunohistochemistry.
Results
Patients (N = 128) had been diagnosed with early-stage cervical cancer (FIGO-2009
stages 1A2, IB1, and IIA1). The combined SLN detection rate (99-technecium and a blue
dye) was 98.4%, bilateral in 76% of the patients. Positive SLNs were found in 19 patients
(14.8%). Sensitivity of detection was 79.2% (CI95, 57.9–92.9), false negative rate
20.8% (CI95, 7.1–42.2), and negative predictive value 95.4% (CI95, 89.6–98.5). False
negative cases were observed in 5 patients with tumors >2 cm and presenting lymphovascular
space invasion. Micrometastases were detected during SLN ultrastaging in 3 patients
(2.3%). The median follow-up was 8.24 years and the 5-year overall survival (OS) was
88.4% (CI95, 80.9–93.1).
Conclusion
SLN mapping and biopsy in early-stage cervical cancer is feasible and has high sensitivity
to detect patients with initial metastases. The risk of false negatives could be lower
in certain groups of patients, such as those with tumors ≤2 cm and no lymphovascular
space invasion, but future studies will be required to test this hypothesis.
Keywords
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Article info
Publication history
Published online: August 07, 2019
Accepted:
July 12,
2019
Received:
June 4,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
