Contribution of lymphoscintigraphy to intraoperative sentinel lymph node detection in early cervical cancer: Analysis of the prospective multicenter SENTICOL cohort.
OBJECTIVE
To evaluate the contribution of preoperative lymphoscintigraphy to intraoperative lymphatic mapping (ILM) in early cervical cancer


METHODS
We conducted an ancillary analysis of the multicenter prospective SENTICOL study in early cervical cancer. Radiocolloid was injected intracervically on the day before (long protocol) or morning of (short protocol) surgery, lymphoscintigraphy was performed, and the results of a centralized image review were communicated to the surgeons. ILM was performed on combined radioactivity/patent blue detection. Sentinel lymph nodes (SLNs) were electively sampled before routine bilateral pelvic lymphadenectomy by laparoscopy.


RESULTS
Of 139 patients in the modified intention-to-diagnose analysis, 114 had centrally reviewed lymphoscintigrams, which showed 352 SLNs in 100 patients. Lymphoscintigraphy and ILM detection rates were 87.8% and 97.8%, respectively. Agreement between lymphoscintigraphy and ILM was low for the number of SLNs (κ=0.23; -0.04; 0.49) and bilateral SLNs (κ=0.36; 0.2; 0.52). No patient without SLNs by ILM had SLNs by lymphoscintigraphy. Lymphoscintigraphy identified substantial proportions of unusual drainage pathways. No patients with metastatic nodes had SLNs by lymphoscintigraphy but not by ILM in the relevant territory. In 1 of the 2 patients with false-negative SLN results, SLNs were bilateral by lymphoscintigraphy and unilateral by ILM.


CONCLUSIONS
Although the detection rate was lower by lymphoscintigraphy than by ILM, the substantial proportions of SLNs in unusual territories provided valuable guidance for the surgical exploration. Awareness of the limited agreement between lymphoscintigraphic and surgical detection might help surgeons decrease the false-negative rate.
Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Chirurgie Cancérologique Gynécologique et du Sein, Paris, France; INSERM UMR-S 747, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. Electronic address: anne-sophie.bats@egp.aphp.fr.
Anne-Sophie
AS
Bats
Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Chirurgie Cancérologique Gynécologique et du Sein, Paris, France.
Albane
A
Frati
Hôpital Femme-Mère-Enfant, Chirurgie Gynécologique, Bron, France; Université Lyon I, Lyon, France.
Patrice
P
Mathevet
Hôpital Edouard Herriot, Médecine Nucléaire, Lyon, France.
Isabelle
I
Orliaguet
Institut Claudius Regaud, Chirurgie Générale, Toulouse, France.
Denis
D
Querleu
Institut Claudius Regaud, Médecine Nucléaire, Toulouse, France.
Slimane
S
Zerdoud
Center Oscar Lambret, Chirurgie Générale, Lille, France.
Eric
E
Leblanc
Center Oscar Lambret, Médecine Nucléaire, Lille, France.
Hélène
H
Gauthier
Institut Gustave Roussy, Chirurgie Générale, Villejuif, France.
Catherine
C
Uzan
Institut Gustave Roussy, Médecine Nucléaire, Villejuif, France.
Désirée
D
Deandreis
Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Gynécologie-Obstétrique, Paris, France.
Emile
E
Darai
Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Médecine Nucléaire, Paris, France.
Khaldoun
K
Kerrou
Hôpital Bretonneau, CHRU de Tours, Gynécologie-Obstétrique, Tours, France.
Henri
H
Marret
Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Département d'Informatique Hospitalière, Evaluation et Gestion des Connaissances, Paris, France.
Emilie
E
Lenain
Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Médecine Nucléaire, Paris, France.
Marc
M
Froissart
Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Chirurgie Cancérologique Gynécologique et du Sein, Paris, France; INSERM UMR-S 747, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
Fabrice
F
Lecuru
D000328:Adult; D015331:Cohort Studies; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D061305:Lymphoscintigraphy / Q000379:methods*; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery
Cervical cancer; Detection; False negative; Lymphoscintigraphy; Sentinel lymph node; Unusual drainage basins