title: Accuracy of intraoperative pathological examination of SLN in cervical cancer.
abstract: OBJECTIVE
  Early cervical cancer patients with pelvic lymph node metastasis do not benefit from radical hysterectomy. Assessment of the SLN status is thus crucial before deciding to perform a radical hysterectomy as opposed to aortic dissection only followed by definitive radiation therapy. Accuracy of frozen section of SLN has been questioned and deserves further investigation.
  
  
  METHODS
  Stage IA-IB1 cervical cancer patients who underwent SLN then full pelvic dissection at the Claudius Regaud Cancer Center in Toulouse, France, were included.
  
  
  RESULTS
  At least one SLN was identified in all 94 patients. Bilateral detection rate was 80.8%. Ectopic drainage area was found in 19 patients (20.2%). Sentinel lymph node involvement was found in 11 patients (11.7%). Sensitivity and NPV of frozen section pathological examination for the detection of macrometastatic disease was 100%, sensitivity for the detection of macro and micrometastatic disease, excluding ITC, was 88.9%, and NPV was 98.8%. Micrometastasis and isolated tumor cells (ITC) undetected at frozen section examination were found in 1 patient (1.06%) and 2 lymph nodes (1.24%), and in 2 patients (2.13%) and 2 lymph nodes (1.24%), respectively. Final pathology sensitivity of SLN was 100% for both macro and micrometastatic disease, including ITC.
  
  
  CONCLUSIONS
  In our institution, intraoperative frozen examination of SLN accurately predicts the status of pelvic lymph nodes and is effective for selecting intraoperatively the group of patients who benefit from radical hysterectomy. In addition, our results suggest that patients with small tumors and bilateral detection of SLN can be spared full pelvic lymphadenectomy.
authors.affiliation: Claudius Regaud Comprehensive Cancer Center, Department of Surgical Oncology, Toulouse, France. martinez.alejandra@claudiusregaud.fr
authors.forename: A
authors.initials: A
authors.lastname: Martínez
authors.forename: E
authors.initials: E
authors.lastname: Mery
authors.forename: T
authors.initials: T
authors.lastname: Filleron
authors.forename: L
authors.initials: L
authors.lastname: Boileau
authors.forename: G
authors.initials: G
authors.lastname: Ferron
authors.forename: D
authors.initials: D
authors.lastname: Querleu
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005629:Frozen Sections / Q000592:standards*; D006801:Humans; D007044:Hysterectomy; D007430:Intraoperative Care; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D061206:Neoplasm Micrometastasis; D009367:Neoplasm Staging; D018579:Patient Selection; D010388:Pelvis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery*; D055815:Young Adult
keywords: Cervical cancer; Frozen section; Micrometastasis; Sentinel lymph node; Ultrastaging