title: Sentinel lymph node biopsy in early-stage cervical cancer: utility of intraoperative versus postoperative assessment.
abstract: OBJECTIVE
  To determine the diagnostic accuracy of sentinel lymph node (SLN) detection using lymphoscintigraphy, intraoperative blue dye, and radiocolloid in patients with early-stage cervical cancer.
  
  
  METHODS
  Intra-cervical injection of technetium-99 sulfur colloid and lymphoscintigraphy were performed preoperatively. Isosulfan blue was injected intra-cervically immediately prior to surgery. SLNs were excised and examined intraoperatively (imprint cytology and frozen section) and postoperatively (H and E histology and immunohistochemistry (IHC) for cytokeratin).
  
  
  RESULTS
  Thirty eight patients were evaluable. Laparoscopy and laparotomy were performed in 28.9% and 71.1%, respectively. Subjects had squamous cell carcinoma (n=26), adenocarcinoma (n=10) or adenosquamous (n=2) histologies. 55.3% had cervical tumors <2 cm. The overall SLN detection rate was 92.1%. The external iliac region just distal to the common iliac bifurcation was the most common SLN location. A mean of 2.1 SLNs were detected per patient with bilateral SLNs observed in 47.4%. On final pathology, metastatic nodal disease was identified in 15.7% of patients. Of these, 83.3% were detected in the SLNs. Sensitivity of SLN detection of metastasis was 100% for patients with cervical tumors <2 cm. However intraoperative evaluation by imprint cytology and frozen section correctly identified lymph node metastasis in only 33.3%.
  
  
  CONCLUSIONS
  SLN detection is feasible and accurately reflects pelvic nodal basin status when performed in early-stage cervical cancer patients. However, while current intraoperative pathology techniques for assessing nodal metastases reliably detect metastases larger than 2 mm, they lack sufficient sensitivity to detect micrometastasis and isolated tumor cells.
authors.affiliation: Department of Obstetrics, School of Medicine, University of Pittsburgh, Magee-Womens Hospital, Pittsburgh, PA 15213, USA.
authors.forename: A Nickles
authors.initials: AN
authors.lastname: Fader
authors.forename: R P
authors.initials: RP
authors.lastname: Edwards
authors.forename: M
authors.initials: M
authors.lastname: Cost
authors.forename: A
authors.initials: A
authors.lastname: Kanbour-Shakir
authors.forename: J L
authors.initials: JL
authors.lastname: Kelley
authors.forename: B
authors.initials: B
authors.lastname: Schwartz
authors.forename: P
authors.initials: P
authors.lastname: Sukumvanich
authors.forename: J
authors.initials: J
authors.lastname: Comerci
authors.forename: J
authors.initials: J
authors.lastname: Sumkin
authors.forename: E
authors.initials: E
authors.lastname: Elishaev
authors.forename: L Cencia
authors.initials: LC
authors.lastname: Rohan
mesh_terms: D005260:Female; D005629:Frozen Sections; D006801:Humans; D007150:Immunohistochemistry; D007430:Intraoperative Care / Q000379:methods; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D009367:Neoplasm Staging; D011182:Postoperative Care / Q000379:methods; D011877:Radionuclide Imaging; D012394:Rosaniline Dyes; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013671:Technetium Tc 99m Sulfur Colloid; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery
chemical_list: D012394:Rosaniline Dyes; C025484:iso-sulfan blue; D013671:Technetium Tc 99m Sulfur Colloid