Sentinel node (SLN) biopsy in the management of locally advanced cervical cancer.
OBJECTIVE
Sentinel lymph node (SLN) biopsy can significantly contribute to the management of locally advanced cervical cancers with high risk of lymph node (LN) positivity. However, low detection rate and sensitivity were reported in larger tumors, albeit on a small number of cases. It was the aim of our study to verify the SLN reliability in large tumors, with modified dye application technique and a careful identification of side-specific lymphatic drainage.


METHODS
The study involved 44 patients with tumors 3 cm in diameter or larger, stages IB1 to IIA, or selected IIB. In cases where SLN could not be detected, systematic pelvic lymphadenectomy was performed on the respective side. Systematic pelvic lymphadenectomy was performed during the second step radical procedure if not already done.


RESULTS
Detection rate in the whole cohort reached 77% per patient and 59% bilaterally. No significant difference was found whether a blue dye or a combined method was used (75% vs 80%, and 55% vs 67%). Systematic pelvic lymphadenectomy was performed in cases with undetected SLN unilaterally in 8 and bilaterally in 10 women. A systematic pelvic lymphadenectomy was included in the second step radical procedure in 19 cases and no positive LN were found. There was no case of false-negative SLN result in patients who underwent surgical treatment.


CONCLUSIONS
Detection rate in locally advanced cervical cancer could be improved by a careful dye application technique. Low false-negative SLN rate could be achieved if pelvic lymphatic drainage is evaluated on a side-specific principle by performing systematic lymphadenectomy if SLN is not detected.
Cibula
D
D
Oncogynecological Center, Department of Obstetrics and Gynecology, General Teaching Hospital in Prague, First Medical School, Charles University, Apolinarska 18, Prague 2, Czech Republic. Electronic address: david.cibula@iol.cz.
Kuzel
D
D
Oncogynecological Center, Department of Obstetrics and Gynecology, General Teaching Hospital in Prague, First Medical School, Charles University, Apolinarska 18, Prague 2, Czech Republic.
Sláma
J
J
Oncogynecological Center, Department of Obstetrics and Gynecology, General Teaching Hospital in Prague, First Medical School, Charles University, Apolinarska 18, Prague 2, Czech Republic.
Fischerova
D
D
Oncogynecological Center, Department of Obstetrics and Gynecology, General Teaching Hospital in Prague, First Medical School, Charles University, Apolinarska 18, Prague 2, Czech Republic.
Dundr
P
P
Department of Pathology, General Teaching Hospital, First Medical School, Charles University, Prague, Czech Republic.
Freitag
P
P
Oncogynecological Center, Department of Obstetrics and Gynecology, General Teaching Hospital in Prague, First Medical School, Charles University, Apolinarska 18, Prague 2, Czech Republic.
Zikán
M
M
Oncogynecological Center, Department of Obstetrics and Gynecology, General Teaching Hospital in Prague, First Medical School, Charles University, Apolinarska 18, Prague 2, Czech Republic.
Pavlista
D
D
Oncogynecological Center, Department of Obstetrics and Gynecology, General Teaching Hospital in Prague, First Medical School, Charles University, Apolinarska 18, Prague 2, Czech Republic.
Tomancova
V
V
Department of Clinical Oncology, General Teaching Hospital, First Medical School, Charles University, Prague, Czech Republic.
D000328:Adult; D000368:Aged; D004396:Coloring Agents; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D012394:Rosaniline Dyes; D021701:Sentinel Lymph Node Biopsy / Q000379:methods* / Q000592:standards; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
D004396:Coloring Agents; D012394:Rosaniline Dyes; C008769:sulfan blue