title: Bilateral negative sentinel nodes accurately predict absence of lymph node metastasis in early cervical cancer: results of the SENTICOL study.
abstract: OBJECTIVE
  Sentinel lymph node (SLN) biopsy may be used to target lymph node metastases in patients with early cervical cancer. Whether SLN biopsy only is acceptable in the staging and surgical management of early cervical cancer remains unknown. This prospective multicenter study (SENTICOL [Ganglion Sentinelle dans le Cancer du Col]) assessed the sensitivity and negative predictive value (NPV) of SLN biopsy.
  
  
  METHODS
  Adults with cervical carcinoma who met the International Federation of Gynecology and Obstetrics criteria for stage IA1 with lymphovascular space invasion to stage IB1 underwent technetium 99 lymphoscintigraphy and Patent Blue injection followed by laparoscopic lymph node mapping, SLN removal, and lymph node dissection. Only surgeons trained in SLN biopsy in cervical carcinoma participated in the study. SLNs and nonsentinel lymph nodes underwent routine staining. Negative SLNs were subjected to ultrastaging. The reference method was pelvic and/or para-aortic lymphadenectomy with histologic examination of all nodes.
  
  
  RESULTS
  One hundred forty-five patients were enrolled, and 139 were included in a modified intention-to-diagnose analysis. Intraoperative radioisotope-blue dye mapping detected at least one SLN in 136 patients (97.8%; 95% CI, 93.8% to 99.6%), 23 of whom had true-positive results and two who had false-negative results, yielding 92.0% sensitivity (23 of 25; 95% CI, 74.0% to 99.0%) and 98.2% NPV (111 of 113; 95% CI, 74.0% to 99.0%) for node metastasis detection. No false-negative results were observed in the 104 patients (76.5%) in whom SLN were identified bilaterally.
  
  
  CONCLUSIONS
  Combined labeling for node mapping was associated with high rates of SLN detection and with high sensitivity and NPV for metastasis detection. However, SLN biopsy was fully reliable only when SLNs were detected bilaterally.
authors: Service de Chirurgie Gynécologique et Cancérologique, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France. fabrice.lecuru@egp.aphp.fr
authors: Fabrice
authors: F
authors: Lécuru
authors: Patrice
authors: P
authors: Mathevet
authors: Denis
authors: D
authors: Querleu
authors: Eric
authors: E
authors: Leblanc
authors: Philipe
authors: P
authors: Morice
authors: Emile
authors: E
authors: Daraï
authors: Henri
authors: H
authors: Marret
authors: Laurent
authors: L
authors: Magaud
authors: Florence
authors: F
authors: Gillaizeau
authors: Gilles
authors: G
authors: Chatellier
authors: Daniel
authors: D
authors: Dargent
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000473:pathology*