title: Sentinel lymph node status in patients with locally advanced cervical cancers and impact of neoadjuvant chemotherapy.
abstract: OBJECTIVE
  Neoadjuvant chemotherapy (NAC) is used in locally advanced cervical cancers with the aim to decrease the size of the tumor and to allow for less radical surgery. Despite of the fact that the high response rate of the tumor has been well established, the impact of NAC on sentinel lymph node (SN) detection and status has not been explored to date.
  
  
  METHODS
  Our study included 82 patients with locally advanced cervical cancers (FIGO IB1 >3 cm, IB2, IIA2 and selected IIB) out of which 51 patients were referred to SN biopsy prior to NAC and 31 patients to radical surgical procedure including SN biopsy after three courses of "dose density" NAC. In both groups, the prevalence of macrometastases, micrometastases and isolated tumor cells (ITC) in SN was compared.
  
  
  RESULTS
  The total of 179 SNs was evaluated. SN detection rate in the whole cohort reached 87.8% per patient and 60.9% bilaterally, without significant difference between both groups. In the group with upfront SN biopsy prior to NAC the prevalence of macrometastases, micrometastases and ITC amounted to 43.1% (22/51), 7.8% (4/51) and 7.8% (4/51) respectively. In the group with SN biopsy after previous NAC, macrometastases were detected in 22.6 (7/31) of patients in SN, whereas there was only one micrometastasis and no ITC detected in that group.
  
  
  CONCLUSIONS
  Neoadjuvant chemotherapy did not influence the detection rate of SNs, yet it was associated with significantly reduced prevalence of metastatic involvement of SNs, especially almost completely eliminating low volume disease.
authors.affiliation: Gynecologic Oncology Center, General Faculty Hospital and 1st School of Medicine, Charles University, Prague, Czech Republic. jiri.slama@vfn.cz
authors.forename: J
authors.initials: J
authors.lastname: Slama
authors.forename: P
authors.initials: P
authors.lastname: Dundr
authors.forename: L
authors.initials: L
authors.lastname: Dusek
authors.forename: D
authors.initials: D
authors.lastname: Fischerova
authors.forename: I
authors.initials: I
authors.lastname: Pinkavova
authors.forename: M
authors.initials: M
authors.lastname: Zikan
authors.forename: P
authors.initials: P
authors.lastname: Vrzackova
authors.forename: M
authors.initials: M
authors.lastname: Kojanova
authors.forename: D
authors.initials: D
authors.lastname: Cibula
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012394:Rosaniline Dyes; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013667:Technetium; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
chemical_list: D012394:Rosaniline Dyes; D013667:Technetium; C008769:sulfan blue