Sentinel Lymph Node Mapping in the Management of Cervical Cancer

Rob, Lukáš

doi:10.1007/978-1-4471-4258-4_34

Cited by 2 publications

(3 citation statements)

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“…Due to the midline location of the cervix in the pelvis, it has several drainage routes, with different authors providing a detailed description of the lymphatic pathways of the cervix and demonstrating that LN drainage is predictable but not uniform 5 . Eighty percent of resected SLNs are located in the external and obturator area, which are called common drainage since they are resected with pelvic lymphadenectomy 6,7 . A non-negligible percentage of SLNs has been observed to be located in nodal chains that are not resected in systematic pelvic lymphadenectomy, such as para-aortic, common iliac, parametrial, and presacral areas, which are called atypical drainage.…”

Section: Introductionmentioning

confidence: 99%

Detecting atypical sentinel lymph nodes in early-stage cervical cancer using a standardized technique with a hybrid tracer

Vila,

Colomer,

Bas

et al. 2024

Preprint

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Background Since October 2018, lymph node (LN) status has become part of the International Federation of Gynaecology and Obstetrics (FIGO) staging, given that it is one of the most important prognostic factors among women with cervical cancer (CC). The aim of this study was to determine the rate of atypical lymphatic drainage in patients with clinical early-stage CC using a hybrid tracer (ICG-99mTc nanocolloid). Methodology A prospective, observational, descriptive, single-centre study conducted at Son Espases University Hospital between January 2019 and October 2023. Patients with clinical early-stage CC who underwent SLN mapping during surgical staging were included. External iliac and obturator nodes were defined as common SLN locations. Para-aortic, common iliac, presacral, internal iliac, and parametrial nodes were defined as uncommon (atypical) locations. Results Thirty-nine cases of CC were included. Overall SLN detection rate was 97.4%, with 89.5% bilaterally. Positive SLNs were found in 21.1% of patients. Atypical lymphatic drainage was present in 8 out of 38 (21.1%). Of the total SLNs (146), 10.3% corresponded to an atypical zone (the most frequent, common iliac vessels). SLNs in the atypical area had a higher proportion of metastasis than the usual area (37.5% vs. 16.7%; p=0.327). Parametrial nodes were detected in 17.9% of patients; two of these (5.2%) with the presence of metastases. In all cases where a parametrial SLN was detected, drainage was also observed to a SLN in a common location. There was no involvement of parametrial lymphatic channels or parametrial nodes in any patient (7/8, 87.5%) with metastatic pelvic SLNs. Conclusion SLN biopsy can detect unusual drainage in a significant proportion of patients with CC. SLNs in atypical locations have a higher percentage of metastatic involvement, which consequently improves staging and tailoring therapy. Our series suggests that lymphatic drainage from the cervical tumour to the pelvic nodes could be a direct route that bypasses parametrial nodes. We suggest that SLN mapping performed by a standardized surgical technique using a hybrid tracer (ICG-99mTc) could help in the identification of the "true sentinel lymph node" and ensure no empty node packet is obtained.

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Section: Introductionmentioning

confidence: 99%

Detecting atypical sentinel lymph nodes in early-stage cervical cancer using a standardized technique with a hybrid tracer

Vila,

Colomer,

Bas

et al. 2024

Preprint

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“…Sentinel node detection rate, bilaterality, sensitivity, and negative predictive value were similar to most other reports in the literature. 7 We would expect bilateral drainage from the cervix, yet only 60-80 % of cases that successfully map have bilateral sentinel nodes, meaning 20-40 % have only unilateral drainage. To account for the lack of bilateral drainage in this minority of patients, an algorithm developed at Memorial Sloan Kettering Cancer Center has gained popularity and acceptance within our field.…”

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confidence: 99%

“…Overall, the detection rate in tumors [2 cm is 80 % compared with a detection rate of 95 % for tumors \2 cm in size. 7 This phenomenon is likely due to difficulty injecting at the interface of the tumor mass and normal tissue, possible increased debris in lymphatic channels from large, necrotic tumors, and higher rates of bulky positive nodes as the tumor size increases.…”

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confidence: 99%

Sentinel Nodes in Cervical Cancer: Surgical Innovation Outside the Ivory Towers

Frumovitz

Ramírez

2014

Ann Surg Oncol

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Lymphatic mapping and sentinel lymph node biopsy have long been established as 'standard of care' in the treatment of malignant melanoma and breast cancer. More recently, large prospective studies have shown its utility in the treatment of women with vulvar cancer, 1,2 and many gynecologic oncologists have learned the technique for treating these patients. As we have become comfortable performing lymphatic mapping in women with vulvar cancer, we have started exploring the procedure in women with uterine and cervical cancers.In theory, cervical cancer is an ideal malignancy for employing lymphatic mapping and sentinel node biopsy. First, the cervix is an 'external' organ, easily accessible for injection to perform preoperative imaging studies such as lymphoscintigraphy or single-photon emission computed tomography/computed tomography (SPECT/CT). Next, only 15-20 % of women with operable cervical cancer (stages IA2-IIA) will have positive pelvic lymph nodes, meaning 80-85 % will be exposed to the morbidities of complete pelvic lymphadenectomy without any benefit. Third, the cervix is a midline organ with fairly reliable drainage to the bilateral pelvic nodes, all of which are easily visualized with a single open incision or through minimally invasive surgery. However, 5 % of women have aberrant drainage to the presacral or low para-aortic lymph nodes, 3 making identification of these basins of great potential benefit as they are typically not part of the standard node dissection for this disease. Finally, the less radical, more precise nature of sentinel lymph node biopsy nicely compliments our field's move towards more minimally invasive approaches for treating women with gynecologic malignancies.However, in reality, gynecologic oncologists are still grappling with whether to adopt sentinel lymph node biopsy as standard of care for women with cervical cancer. Unlike the high incidence of melanoma (76,100 new cases/ year) or breast cancer (235,030 new cases/year), cervical cancer is a rare cancer in the developed world with only 12,360 new cases in the US this year, 4 of which less than half will be operable candidates. Due to the rarity of the disease, large, prospective studies to prove its safety and utility have been difficult to perform. Although two multicenter studies have been performed in Europe with mixed results, 5,6 most of our data regarding sentinel node biopsy for treating women with cervical cancer have come from single-institution studies.In this month's issue of Annals of Surgical Oncology, Freitas and colleagues present their data on 57 patients with early-stage cervical cancer who underwent lymphatic mapping and sentinel node biopsy followed by complete pelvic lymphadenectomy. They found a sentinel node detection rate of 84 %, with bilaterality in 58 % of these cases. Overall, the sensitivity of the procedure was 89 %, with a negative predictive value of 98 %. Sentinel node detection rate, bilaterality, sensitivity, and negative predictive value were similar to most other reports in the literat...

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Sentinel Lymph Node Mapping in the Management of Cervical Cancer

Cited by 2 publications

References 47 publications

Detecting atypical sentinel lymph nodes in early-stage cervical cancer using a standardized technique with a hybrid tracer

Detecting atypical sentinel lymph nodes in early-stage cervical cancer using a standardized technique with a hybrid tracer

Sentinel Nodes in Cervical Cancer: Surgical Innovation Outside the Ivory Towers

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