Sentinel lymph node biopsy as guidance for radical trachelectomy in young patients with early stage cervical cancer

Abstract

BackgroundThe purpose of this study was to assess the feasibility and accuracy of sentinel lymph nodes (SLNs) detection using 99mTc phytate in predicting pelvic lymph nodes status for radical abdominal trachelectomy (RAT) in patients with early stage cervical cancer.MethodsSixty-eight women with stage IA2-IB1 cervical cancer and scheduled to undergo fertility-sparing surgery enrolled in this study. 99mTc-labeled phytate was injected before surgery. Intraoperatively, SLNs were identified, excised, and submitted to fast frozen section. Systematic bilateral pelvic lymphadenectomy and/or para-aortic lymph node dissection was performed. Then RAT was performed in patients with negative SLNs. All nodes were sent for routine pathological examination and immunostained with anti-cytokeratin antibody to detect micrometastases. Outcomes of follow up and fertility were observed.ResultsSLNs were identified in 64 of 68 patients (94.1%). Of these, SLNs of 8 patients (11.8%) were positive on frozen sections and proved to be metastasis by final pathologic examination. The sensitivity, accuracy, and false negative rates were 100%, 100%, and 0%, respectively. All 60 patients with negative SLN underwent RAT successfully. Two relapses occurred and no one died of tumor progression during follow-up. Five of the 15 patients with procreative desire conceived 8 pregnancies (3 term delivery, 2 premature birth, 1 spontaneous abortion, and 2 were still in the duration of pregnancy) after surgery.ConclusionsThe identification of SLN using 99mTc-labeled phytate is accurate and safe to assess pelvic nodes status in patients with early cervical cancer. SLNs biopsy guided RAT is feasible for patients who desire to have fertility preservation.

Sentinel Lymph Node Evaluation in Women with Cervical Cancer

“…[15–17] Though radiation doses are variable based upon which protocol is used, overall radiation exposure remains small. Intracervical injection techniques are similar to those described for blue dye.…”

“…Many published studies utilize a “long” protocol, whereby the tracer is injected intracervically the day prior to surgery. [15, 17, 19, 20] In these studies, preoperative imaging with lymphoscintigraphy or SPECT-CT is performed so that the surgeon will have this information ahead of proceeding to the operating room. If the isotope is injected less than 24 hours from surgery, reinjection is often unnecessary as the half-life of isotope is approximately 6 hours.…”

“…[9–11] When radioisotope alone is used for sentinel lymph node mapping in these women, detection rates are comparable to that of blue dye at 88% – 94%. [15–17] However, when blue dye and radioisotope are combined to map lymph nodes in cervical cancer patients, the detection rates appear to be improved over either modality alone. [21, 23] In their study of more than 200 women, Roy and colleagues found that the combined method of lymphatic mapping has a detection rate of 99.1%, compared to the 92.8% rate of blue dye alone (p=0.009).…”

Bilateral ultrastaging of sentinel lymph node in cervical cancer: Lowering the false-negative rate and improving the detection of micrometastasis

“…fertility-sparing treatment [5]. Furthermore, detection of nodal metastasis is potentially improved by pathologic ultrastaging, which includes multiple serial sectioning and immunohistochemical assessment of the SN.…”

90. Randomized comparison of near-infrared fluorescence lymphatic tracers for sentinel lymph node mapping of cervical cancer

“…Large studies in early-stage cervical cancer patients using radiocolloid tracers reported higher detection rates varying from 88% to 99% (17)(18)(19)(20)(21)(22)(23). Possible explanations for the lower detection rate observed in this study could be the inclusions of patients with larger tumors (>2 cm) and, especially, the learning curve associated with cervical injection of the tracer and the intraoperatively exposure of tissue to maximize NIR fluorescence detection (17;24).…”