Sentinel node detection with (99m)Tc phytate alone is satisfactory for cervical cancer patients undergoing radical hysterectomy and pelvic lymphadenectomy.
BACKGROUND
If the sentinel-lymph-node (SLN) concept is valid in cervical cancer, most patients could avoid pelvic lymphadenectomy when absence of metastasis is intraoperatively confirmed in the SLN. We assessed feasibility and accuracy of SLN detection using (99m)Tc phytate in patients with cervical cancer.


METHODS
Eighty-two women with stage Ia-IIb cervical cancer enrolled in this study. All underwent hysterectomy or trachelectomy with accompanying total pelvic lymphadenectomy. On the day before surgery, we injected fluid containing (99m)Tc-labeled phytate subepithelially into four cervical quadrants outside the tumor. Intraoperatively, SLNs were identified as radioactive "hot nodes" by gamma probe. Systematic bilateral pelvic lymphadenectomy was performed after the hot node sampling to evaluate the predictive ability of hot nodes.


RESULTS
A total of 157 lymph nodes were detected as SLNs in 72 of 82 patients. SLN detection rate was 88%. Detection rate was 95% for the subgroups of patients with stage Ia-Ib1 disease and smaller tumor size (<or=3 cm in maximal diameter). Lymph node metastasis was found in 15 patients. In 3 of them, no SLNs were detected. In the remaining 12 patients, each ipsilateral SLN contained metastasis when the pelvic lymph nodes contained metastases. Sensitivity was 100%, the false negative rate was 0%, and the negative predictive value of SLN was 100%.


CONCLUSIONS
We conclude SLN detection using (99m)Tc-labeled phytate is satisfactory to assess pelvic nodes in patients with early cervical cancer; if validated with other research, it should be incorporated into clinical practice.
Ogawa
Shinji
S
Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
Kobayashi
Hiroaki
H
Amada
Satoshi
S
Yahata
Hideaki
H
Sonoda
Kenzo
K
Abe
Koichiro
K
Baba
Shingo
S
Sasaki
Masayuki
M
Kaku
Tsunehisa
T
Wake
Norio
N
D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008875:Middle Aged; D010833:Phytic Acid; D011877:Radionuclide Imaging; D013667:Technetium; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery
D013667:Technetium; D010833:Phytic Acid