Sentinel node procedure in Ib cervical cancer: a preliminary series

Abstract

The aim of this study was to determine the diagnostic accuracy and feasibility of sentinel lymph node (SLN) detection using a gamma probe in patients with Figo IB cervical cancer. Between January 1999 and September 2000, 14 patients with cervical cancer, planned for radical hysterectomy were eligible for the study. The day before radical hysterectomy we injected technetium 99 m-labelled nanocolloid in each quadrant of the cervix. Dynamic and static images were recorded using a gamma camera. SLNs were identified intraoperatively using a handheld gamma-detection probe. After resection of SLNs a standard radical hysterectomy with pelvic lymph node dissection was performed. Patients and tumour characteristics were compared with sentinel node detection and with final histopathological and immunohistochemical results. Scintigraphy showed focal uptake in 13 of the 14 patients. Intraoperatively we detected 26 sentinel nodes by gamma probe. In 8 of 13 patients, one or more sentinel nodes were identified unilaterally, in 5 women bilaterally. Histologically positive SLNs were found in only 1 patient. We did not find any false-negative SLN in our series. In conclusion identification of sentinel nodes in cervical cancer is feasible with preoperatively administered technetium 99 m-labelled nanocolloid. A larger series will be required to establish sentinel node detection in cervical cancer for further therapy concepts and planning. © 2001 Cancer Research Campaign http://www.bjcancer.com

Laparoscopic sentinel lymph node procedure using a combination of patent blue and radioisotope in women with cervical carcinoma

“…The sensitivity of the SN procedure ranged from 87% to 100% with an accuracy rate of 100% and without specific morbidity. [13][14][15][16]22,23 In the current study, SN detection was possible in patients who had undergone neoadjuvant chemotherapy and radiotherapy. No previous data were available on the SN procedure in women with cervical carcinoma who were treated first with chemotherapy or radiotherapy.…”

“…Previous IHC studies of SN showed no micrometastases. 16,22,23 Similar to patients with breast carcinoma, the prognostic significance of micrometastases is controversial in patients with cervical carcinoma. At our institution, their presence does not influence the treatment regimen.…”

“…27 In the current series, no metastatic lymph nodes were found when the SN were negative, in keeping with several previous studies. [13][14][15]20,23,25,28 In contrast, Levenback et al 16 reported a false-negative result in a patient with a positive medial parametrial lymph node that was resected with the primary tumor and was not located with blue dye or a ␥ probe. Malur et al 21 observed 1 false-negative result in a series of 50 patients but did not state the location of the positive lymph node.…”

Sentinel node detection in N0 cancer of the pharynx and larynx

“…British Journal of Cancer (2002) Paralell to other tumour entities there were intensified efforts within the last two decades, which are still discussed controversially, to limit the extent of lymph node dissection in the clinically staged N0 situations also for head and neck cancer patients. The aim of reducing a potential excess of surgical therapy for the patient is currently achieved quite successfully in other tumour entities by applying the so-called sentinel node (SN) concept (Lingam et al, 1997;De Cicco et al, 2000;Lantzsch et al, 2001). The extensive investigations on large patient cohorts in breast cancer and malignant melanoma are opposed by a comparative paucity of experience with the SN concept for SCC of the upper aerodigestive tract (Pitman et al, 1998;Shoaib et al, 1999Shoaib et al, , 2001Alex et al, 2000;Chiesa et al, 2000;Colnot et al, 2001;Stoeckli et al, 2001).…”

Sentinel lymph node biopsy is not accurate in predicting lymph node status for patients with cervical carcinoma

“…In some studies, 10 -15 SLN biopsy was performed via laparotomy, whereas other investigators 5,16 -18 used laparoscopy. In addition, the method of detection varied from study to study, with some investigators using only blue dye injection, 5,13,15 some using only radioisotope injection, 11,16 and some using a combination of these two methods. 10,12,14,17,18 Our preliminary study 5 indicated that SLN biopsy was reliable in predicting the status of the pelvic lymph nodes, with a negative predictive value of 100% for pelvic SLNs and NSLNs when classical pathologic evaluation techniques were used.…”