title: Intraoperative lymphatic mapping in cervix cancer patients undergoing radical hysterectomy: A pilot study.
abstract: OBJECTIVE
  Intraoperative lymphatic mapping and sentinel lymph node identification (SLN) have been increasingly evaluated in the treatment of a variety of solid tumors, particularly breast cancer and melanoma. We sought to evaluate the feasibility of these procedures in patients undergoing radical hysterectomy with pelvic lymphadenectomy for treatment of early cervical cancer.
  
  
  METHODS
  Twenty patients with normal-appearing lymph nodes underwent intracervical injection of isosulfan blue dye (lymphazurin 1%) at the time of planned radical hysterectomy and bilateral pelvic/low paraortic lymphadenectomy (40 nodal basins). Regional lymphatic tissue was inspected for dye uptake into lymphatic channels and lymph nodes. Tumor characteristics, surgical findings, and specific locations of lymphatic dye uptake were recorded and correlated with final pathology results.
  
  
  RESULTS
  Sentinel lymph nodes were identified in 12 of 20 (60%) patients. A total of 23 sentinel nodes were identified in 17 of 40 (43%) nodal basins dissected (range: 0-2 per basin). Successful SLN identification was less likely in patients with tumors >4 cm compared with those with tumors </=4 cm (P = 0.035). Of 4 patients with metastatic nodal disease, 3 had tumor involving a SLN; the fourth had no identifiable SLN (inadequate study). In all, 3 of 8 lymph nodes with confirmed metastatic disease were identified using this technique.
  
  
  CONCLUSIONS
  SLN identification and intraoperative lymphatic mapping are feasible and safe. Lymphatic dye uptake appears to be less reliable in patients with larger tumors. Although sentinel node pathology was representative of the lymphatic basin sampled in all cases, the rate of SLN identification was low with this technique. Lymphatic mapping procedures should be further investigated in the treatment of early cervix cancer.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Suite J7.124, Dallas, Texas, 75235-9032, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: O'Boyle
authors.forename: R L
authors.initials: RL
authors.lastname: Coleman
authors.forename: S G
authors.initials: SG
authors.lastname: Bernstein
authors.forename: S
authors.initials: S
authors.lastname: Lifshitz
authors.forename: C Y
authors.initials: CY
authors.lastname: Muller
authors.forename: D S
authors.initials: DS
authors.lastname: Miller
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D007430:Intraoperative Care; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D010388:Pelvis; D010865:Pilot Projects; D021701:Sentinel Lymph Node Biopsy; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery*