Sentinel lymph node mapping and intraoperative assessment in a prospective, international, multicentre, observational trial of patients with cervical cancer: The SENTIX trial

Cibula, David; Kocián, Roman; Plaikner, Andrea; Jarkovský, Jiří; Klát, Jaroslav; Zapardiel, Ignacio; Pilka, R; Torné, Aureli; Sehnal, Borek; Ostojich, Marcela; Petiz, Almerinda; Sanchez, O Arencibia; Presl, J; Buda, Alessandro; Raspagliesi, Francesco; Kaščák, Peter; Lonkhuijzen, Luc van; Barahona, Marc; Minář, Luboš; Blecharz, Paweł; Pakiž, Maja; Wydra, Dariusz; Snyman, Leon Cornelius; Zalewski, Kamil; Zorrero, Cristina; Havelka, P; Redecha, M; Vinnytska, Alla; Vergote, Ignace; Tingulstad, Solveig; Michał, M; Kipp, Barbara; Sláma, Jiří; Marnitz, Simone; Bajsová, Sylva; Hernández, Alicia; Fischerová, D.; Němejcová, Kristýna; Köhler, Christian

doi:10.1016/j.ejca.2020.06.034

Cited by 74 publications

(48 citation statements)

References 34 publications

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“…The SENTIREC CERVIX study is, to our knowledge, the first prospective national study to investigate the accuracy of SLN mapping in a large homogeneous sample of women with early-stage cervical cancer and tumor size >20 mm on final pathology. Earlier studies have reported on mixed samples with different risk profiles regarding tumor size [6,8,[25][26][27]. Increasing tumor diameter is known to be associated with poorer prognosis [2,24].…”

Section: Discussionmentioning

confidence: 99%

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Sentinel lymph node mapping in early-stage cervical cancer – A national prospective multicenter study (SENTIREC trial)

Sponholtz

Mogensen

Schledermann

et al. 2021

Gynecologic Oncology

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The sentinel node detection rate is high in women with early-stage cervical cancer; 96.3% with 82.0% bilateral detection • Sentinel node mapping has a sensitivity of 96.3% and a negative predictive value of 98.7% in women with tumor size >20 mm • Adherence to the sentinel node mapping algorithm is crucial in maintaining high sensitivity in women with tumors >20 mm • FDG-PET/CT for nodal staging of women with early-stage cervical cancer seems limited if sentinel node mapping is performed

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Section: Discussionmentioning

confidence: 99%

“…Further, the SENTICOL 2 trial excluded women with unilateral SLN mapping from their survival analyses due to a previously shown higher risk of false-negative SLNs in failed mapping. The same approach was used in the prospective SENTIX study [27]. In our study, no women were excluded due to unilateral mapping.…”

Section: Discussionmentioning

confidence: 99%

Sentinel lymph node mapping in early-stage cervical cancer – A national prospective multicenter study (SENTIREC trial)

Sponholtz

Mogensen

Schledermann

et al. 2021

Gynecologic Oncology

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“…After the surgery, patients were registered if they met additional intraoperative criteria: bilateral SLN detection, no metastasis of any size found on frozen sections, and no evidence of more advanced disease ( Figure 1 ). All retrieved sentinel lymph nodes were consequently processed by ultrastaging protocol, as described elsewhere [ 24 ].…”

Section: Methodsmentioning

confidence: 99%

“…The main motive for introducing sentinel lymph node (SLN) biopsy as a replacement of standard systematic pelvic lymphadenectomy (PLND) is to decrease postoperative morbidity, specifically the development of LLL. Since the average number of SLN among cervical cancer patients is between 2–4 and removal of SLN does not usually require a complete dissection of pelvic spaces and interruption of all main lymphatic trunks, substantial reduction of LLL is expected after SLN biopsy without systematic PLND [ 24 , 25 , 26 ]. Implementation of SLN biopsy was already shown to be an effective strategy in reducing the incidence of LLL after treatment of endometrial or vulvar cancer [ 27 , 28 , 29 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

Lower-Limb Lymphedema after Sentinel Lymph Node Biopsy in Cervical Cancer Patients

Cibula

Borčinová

Marnitz

et al. 2021

Cancers

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Background: To prospectively assess LLL incidence among cervical cancer patients treated by uterine surgery complemented by SLN biopsy, without PLND. Methods: A prospective study in 150 patients with stage IA1–IB2 cervical cancer treated by uterine surgery with bilateral SLN biopsy. Objective LLL assessments, based on limb volume increase (LVI) between pre- and postoperative measurements, and subjective patient-perceived swelling were conducted in six-month periods over 24-months post-surgery. Results: The cumulative incidence of LLL at 24 months was 17.3% for mild LLL (LVI 10–19%), 9.2% for moderate LLL (LVI 20–39%), while only one patient (0.7%) developed severe LLL (LVI > 40%). The median interval to LLL onset was nine months. Transient edema resolving without intervention within six months was reported in an additional 22% of patients. Subjective LLL was reported by 10.7% of patients, though only a weak and partial correlation between subjective-report and objective-LVI was found. No risk factor directly related to LLL development was identified. Conclusions: The replacement of standard PLND by bilateral SLN biopsy in the surgical treatment of cervical cancer does not eliminate the risk of mild to moderate LLL, which develops irrespective of the number of SLN removed.

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“…More recently, the sentinel lymph node (SLN) technique has been proposed with promising results in terms of sensitivity in diagnosing lymph node metastasis [ 8 , 9 ]. Nevertheless, even though the ultrastaging of SLN at final pathology increases its negative predictive value by diagnosing low-volume metastases, different studies questioned the role of frozen section of SLN, with sensitivity ranging from 46.0%to 87.5% [10] , [11] , [12] . For this reason, the use of a frozen section of SLN may not be the best tool to triage patients to radical hysterectomy versus definitive chemoradiation [12] .…”

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confidence: 99%

Radiomic models for lymph node metastasis prediction in cervical cancer: can we think beyond sentinel lymph node?

Bizzarri

Boldrini

Ferrandina

et al. 2021

Translational Oncology

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Liu and colleagues performed a retrospective study to validate a computed tomography (CT) scan-based radiomic model to detect lymph node metastasis in cervical cancer. The proposed model incorporating the arterial and venous phase CT-scan features represented a non-invasive method exhibiting high sensitivity in the prediction of lymph node metastasis. It is well established that lymph node metastasis is one of the most significant prognostic factors in cervical cancer. For this reason, management of cervical cancer is strictly related to lymph node status, with international guidelines recommending definitive chemo-radiation in case of metastatic lymph node. More and more evidence supports the use of sentinel lymph node in early-stage cervical cancer but its frozen section analysis may result in false negative results; in locally-advanced stages staging para-aortic lymphadenectomy is proposed by many Authors to tailor chemoradiotherapy treatment, with potential intra-and post-operative related complications. The use of a validated radiomic model able to predict lymph node metastases in radiologically normal lymph nodes may represent an essential tool to possibly spare lympadenectomy related morbidity.

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Sentinel lymph node mapping and intraoperative assessment in a prospective, international, multicentre, observational trial of patients with cervical cancer: The SENTIX trial

Cited by 74 publications

References 34 publications

Sentinel lymph node mapping in early-stage cervical cancer – A national prospective multicenter study (SENTIREC trial)

Sentinel lymph node mapping in early-stage cervical cancer – A national prospective multicenter study (SENTIREC trial)

Lower-Limb Lymphedema after Sentinel Lymph Node Biopsy in Cervical Cancer Patients

Radiomic models for lymph node metastasis prediction in cervical cancer: can we think beyond sentinel lymph node?

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