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.
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.
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).
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.
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- Sentinel lymph node mapping in cervical cancer: the future?.BJOG. 2012; 119: 129-133
- Impact of lower limb lymphedema on quality of life in gynecologic cancer survivors after pelvic lymph node dissection.Eur J Obstet Gynecol Reprod Biol. 2015; 192: 31-36
- Topographic distribution of sentinel lymph nodes in patients with cervical cancer.Gynecol Oncol. 2006; 103: 35-44
- Bilateral negative sentinel nodes accurately predict absence of lymph node metastasis in early cervical cancer: results of the SENTICOL study.J Clin Oncol. 2011; 29: 1686-1691
- ESGO survey on current practice in the management of cervical cancer.Int J Gynecol Cancer. 2018; 28: 1226-1231
- The sentinel node technique detects unexpected drainage pathways and allows nodal ultrastaging in early cervical cancer: insights from the multicenter prospective SENTICOL study.Ann Surg Oncol. 2013; 20: 413-422
- Lymph node staging by positron emission tomography in patients with carcinoma of the cervix.J Clin Oncol. 2001; 19: 3745-3749
- NCCN guidelines version 2.2019 cervical cancer. NCCN clinical practice guidelines in oncology.2018
- Sentinel lymph node (SLN) concept in cervical cancer: current limitations and unanswered questions.Gynecol Oncol. 2018;
- Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium.Int J Gynaecol Obstet. 2009; 105: 103-104
- Sentinel lymph node identification and radical hysterectomy with lymphadenectomy in early stage cervical cancer: laparoscopy versus laparotomy.J Minim Invasive Gynecol. 2008; 15: 531-537
- Total laparoscopic radical trachelectomy with intraoperative sentinel node identification for early cervical stump cancer.J Minim Invasive Gynecol. 2005; 12: 522-524
- Total laparoscopic radical hysterectomy with intraoperative sentinel node identification in patients with early invasive cervical cancer.Gynecol Oncol. 2005; 96: 187-193
- Images in clinical medicine. Anaphylaxis associated with blue dye.N Engl J Med. 2012; 367: 2026
- Change in clinical management of sentinel lymph node location in early stage cervical cancer: the role of SPECT/CT.Gynecol Oncol. 2011; 120: 353-357
- Update on the Querleu-Morrow Classification of Radical Hysterectomy.Ann Surg Oncol. 2017; : 3406-3412
- Sentinel lymph node procedure in endometrial cancer: a systematic review and proposal for standardization of future research.Gynecol Oncol. 2015; 138: 478-485
- Impact of indocyanine green for sentinel lymph node mapping in early stage endometrial and cervical cancer: comparison with conventional radiotracer (99m)Tc and/or blue dye.Ann Surg Oncol. 2016; 23: 2183-2191
- The efficacy of sentinel lymph node mapping with indocyanine green in cervical cancer.World J Surg Oncol. 2018; 16: 52
- Sentinel node mapping in cervical and endometrial cancer: indocyanine green versus other conventional dyes-a meta-analysis.Ann Surg Oncol. 2016; 23: 3749-3756
- Establishing a sentinel lymph node mapping algorithm for the treatment of early cervical cancer.Gynecol Oncol. 2011; 122: 275-280
- The sentinel node procedure in early stage cervical cancer, taking the next step; a diagnostic review.Gynecol Oncol. 2015; 139: 559-567
- Sentinel lymph node biopsy improves staging in early cervical cancer.Gynecol Oncol. 2007; 105: 189-193
- Cost-effectiveness of sentinel node biopsy and pathological ultrastaging in patients with early-stage cervical cancer.Cancer. 2017; 123: 1751-1759
- Prognostic significance of low volume sentinel lymph node disease in early-stage cervical cancer.Gynecol Oncol. 2012; 124: 496-501
- Lymph node micrometastases in initial stage cervical cancer and tumoral recurrence.Int J Gynaecol Obstet. 2016; 133: 69-75
- Risk of micrometastases in non-sentinel pelvic lymph nodes in cervical cancer.Gynecol Oncol. 2016; 143: 83-86
- Diagnostic value of intraoperative examination of sentinel lymph node in early cervical cancer: a prospective, multicenter study.Gynecol Oncol. 2011; 123: 230-235
- Accuracy of intraoperative pathological examination of SLN in cervical cancer.Gynecol Oncol. 2013; 130: 525-529
- High false negative rate of frozen section examination of sentinel lymph nodes in patients with cervical cancer.Gynecol Oncol. 2013; 129: 384-388
- One-step nucleic acid amplification (OSNA) for the detection of sentinel lymph node metastasis in endometrial cancer.Gynecol Oncol. 2016; 143: 54-59
- Detection of sentinel lymph node metastases in cervical cancer: assessment of KRT19 mRNA in the one-step nucleic acid amplification (OSNA) method.Gynecol Oncol. 2013; 130: 530-536
- SLN biopsy in cervical cancer patients with tumors larger than 2cm and 4cm.Gynecol Oncol. 2018; 148: 456-460
- Trends of cervical cancer mortality in the member states of the European Union.Eur J Cancer. 2009; 45: 2640-2648
Published online: August 07, 2019
Accepted: July 12, 2019
Received: June 4, 2019
© 2019 Elsevier B.V. All rights reserved.