To evaluate patterns of lymph flow from primary lesions in patients with cervical cancer and to determine how useful for radiotherapy planning this information can be. Materials and methods: SPECT-CT visualization of sentinel (SLN) lymph nodes (LNs) was performed in 36 primary patients with IB-IIB cervical cancer. The acquisition started 120-240 min after 4 peritumoral injections of 99mTc-radiocolloids (150-300 MBq in 0.4-1 ml). We determined localization of LN with uptake of radiocolloids, type of lymph flow (mono-, bilateral) and lymph flow patterns (supraureteral paracervical, infraureteral paracervical and directly to para-aortic LNs). Results: SLNs were visualized in 31 of 36 women. Bilateral lymph-flow was detected in 22 (71%), monolateral-in the other 9 (29%) cases. The distribution of SLNs was as follows: external iliac-64.5%, internal iliac-54.8%, obturator-32.2%, common iliac-35.5% and pre-sacral 3.2%. Para-aortic LNs were visualized in 5 (16.1%) patients. The supraureteral paracervical pattern of lymph flow was identified in 22, infraureteral paracervical-in 4 and their combination-in the other 5 women. Conclusion: Visualization of an individual pattern of lymph flow from primary cervical cancer can be considered as a promising tool for optimization of the volume of irradiated regional LNs.

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Purpose: to determine preoperative SPECT-CT localization of sentinel lymph nodes (SLN) in women with cervical cancer. Materials and methods: SPECT-CT visualization of SLN was performed in 44 women with clinical stage IB-IIB cervical cancer. SPECT-CT examinations started 120-240 min after peritumoural injections of 99mTc-radiocolloids (200-300MBq in 0.4-1ml). All visualized LNs with uptake of radiocolloids were regarded as SLN. In all women we determined topography of SLN and lymph-flow patterns. Results: SLN were successfully visualized in 93.1% cases (41/44 women). The bilateral pattern of lymph flow was mentioned in 26 (63.4%), monolateral - in 15 (36.5%) cases. SLN localized in external iliac region in 25 (60.9%), internal iliac - in 14 (34.1%), obturator - in 22 (53.6%), presacral - in 1 (2.4%), common iliac region - in 21 (53,8%) cases. Uptake of radiocolloids in paraaortal lymph nodes was mentioned in 14 (34.1%) women Conclusion: SPECT-CT visualization of SLN can give important information for surgery and radiotherapy planning.

Purpose: to determine accuracy of sentinel lymph node biopsy in patients with IAB-IIAB cervical cancer. Materials and methods: diagnostic performance of sentinel lymph node (SLN) biopsy was evaluated in 46 women with cervical cancer. SLN mapping was performed after peritumoural injection of 99mTc-labelled radiocolloids. All regional lymph nodes with uptake of radiocolloids were regarded as sentinel. SSLN biopsy was completed by standard lymph node dissection in all cases Results: SLN were visualized and detected in 42 of 46 (91.3%) cases. The monolateral pattern of lymph flow was determined in 19 women, bilateral localization of SLN revealed in remained 23 cases. Monolateral lymph flow characterized by high probability of metatstic involvement of regional lymph nodes (21.1%) and low sensitivity of SLN biopsy (0%). On the contrary, in women with bilateral lymph flow metastases in regional lymph nodes were mentioned in 2 of 23 cases (8.7%) and sensitivity of SLN biopsy was 100%. Conclusion: In patients with SLN localization on both sides of the pelvis SLN biopsy correctly predicted status of regional lymph nodes. In cases with monolateral localization of SLN biopsy characterized by high false negative rates.

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