title: A prospective single-center study of sentinel lymph node detection in cervical carcinoma: is there a place in clinical practice?
abstract: OBJECTIVE
  To establish the accuracy of sentinel lymph node (SLN) detection in early cervical cancer.
  
  
  METHODS
  Sentinel lymph node detection was performed prospectively over a 6-year period in 86 women undergoing surgery for cervical carcinoma by the combined method (Tc-99m and methylene blue dye). Further ultrastaging was performed on a subgroup of 26 patients who had benign SLNs on initial routine histological examination.
  
  
  RESULTS
  The SLN was detected in 84 (97.7%) of 86 women by the combined method. Blue dye uptake was not seen in 8 women (90.7%). Sentinel lymph nodes were detected bilaterally in 63 women (73.3%), and the external iliac region was the most common anatomic location (48.8%). The median SLN count was 3 nodes (range, 1-7). Of the 84 women with sentinel node detection, 65 also underwent bilateral pelvic lymph node dissection, and in none of these cases was a benign SLN associated with a malignant non-SLN (100% negative predictive value). The median non-SLN count for all patients was 19 nodes (range, 8-35). Eighteen patients underwent removal of the SLN without bilateral pelvic lymph node dissection. Nine women (10.5%) had positive lymph nodes on final histology. One patient had bulky pelvic nodes on preoperative imaging and underwent removal of the negative bulky malignant lymph nodes and a benign SLN on the contralateral side. This latter case confirms the unreliability of the SLN method with bulky nodes. The remaining 8 patients had positive SLNs with negative nonsentinel lymph nodes. Fifty-nine SLNs from 26 patients, which were benign on initial routine histology, underwent ultrastaging, but no further disease was identified. Four patients (5%) relapsed after a median follow-up of 28 months (range, 8-80 months).
  
  
  CONCLUSIONS
  Sentinel lymph node detection is an accurate and safe method in the assessment of nodal status in early cervical carcinoma.
authors.affiliation: Department of Gynaecological Oncology, Maidstone Hospital, Kent Oncology Centre, Maidstone, Kent, United Kingdom. o.devaja@nhs.net
authors.forename: Omer
authors.initials: O
authors.lastname: Devaja
authors.forename: Gautam
authors.initials: G
authors.lastname: Mehra
authors.forename: Michael
authors.initials: M
authors.lastname: Coutts
authors.forename: Stephen Attard
authors.initials: SA
authors.lastname: Montalto
authors.forename: John
authors.initials: J
authors.lastname: Donaldson
authors.forename: Mallikarjun
authors.initials: M
authors.lastname: Kodampur
authors.forename: Andreas John
authors.initials: AJ
authors.lastname: Papadopoulos
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000473:pathology*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D055815:Young Adult