Study of lymphatic mapping and sentinel node identification in early stage cervical cancer.
OBJECTIVE
The aim of our study was to compare the identification of sentinel lymph nodes (SLN) by blue dye and (99m) Tc; to evaluate detection rate per patient and specific side detection rate (SSDR) of SLN, distribution of SLN and distribution of positive SLN and false negative rate of the methods.


METHODS
From February 2000 until September 2004, we included 183 women with early stage cervical carcinoma. We evaluated two methods of detection of SLN (100 cases by Patent blue, 83 cases by Patent blue with (99m)Tc). We stratified the group upon the size of the tumor and upon the type of surgical method (laparoscopy, laparotomy).


RESULTS
SLN identification increased in cases when we used combination of both methods (Tc + blue dye) SSDR = 93% versus the use of blue dye only SSDR = 71% (OR:5,76, CI 95% -2.9 -11.4, <0.0001). Distribution of 462 SLN-45.0% external iliac artery and vein, 42.6% supraobturator, 4.8 bifurcation and common illiac artery and vein, 4.6% praesacral, 3% medial part of lateral parametrium. Distribution of 44 positive SLN-approximately 38.6% external illiac artery and vein, 45.5% supraobturator, 6.8% bifurcation and common illiac artery and vein, 4.5% praesacral, 4.5% medial part of lateral parametrium. One false negative SN was in presacral area.


CONCLUSIONS
Detection of SLN by combination of (99m)Tc and blue dye was statistically significantly better than blue dye alone. Our study documents high sensitivity, specificity and low false negativity of the method.
Rob
Lukas
L
Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, Charles University Prague, 2nd Medical Faculty, V uvalu 84, 15000 Prague 5, Czech Republic. lukas.rob@lfmotol.cuni.cz
Strnad
Pavel
P
Robova
Helena
H
Charvat
Martin
M
Pluta
Marek
M
Schlegerova
Dana
D
Hrehorcak
Martin
M
D000328:Adult; D000368:Aged; D004396:Coloring Agents; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013668:Technetium Tc 99m Aggregated Albumin; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology*
D004396:Coloring Agents; D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; D013668:Technetium Tc 99m Aggregated Albumin; C008769:sulfan blue