Location of Sentinel Lymph Node in Cervical Carcinoma and Factors Associated With Unilateral Detection.
OBJECTIVE
The aims of this study were to assess locality of the sentinel lymph node (SLN) in cervical carcinoma and examine factors affecting bilateral SLN detection.


METHODS
This was a retrospective review of SLN data (anatomical location, count and laterality) in patients with early-stage cervical cancer (International Federation of Gynecology and Obstetrics stage IA1 with lymphovascular space invasion to stage IIA) using intraoperative gamma probe and blue dye. The preoperative single-photon emission computed tomography with computed tomography was used to detect laterality, number of the SLNs, and rare locations. Patients were treated between January 2005 to January 2015 at the West Kent Gynaecological Oncology Centre, Maidstone Hospital, Maidstone, United Kingdom.


RESULTS
A total of 132 women were investigated. The most common SLN location was the external iliac (38.6%) followed by obturator (25.3%) and internal iliac (23.6%) regions. A small percentage was identified in presacral (1.4%) and para-aortic regions (0.7%). Older age (P = 0.01) and an elevated body mass index (P = 0.03) were associated with decreased SLN count by preoperative single-photon emission computed tomography with computed tomography, and only age affected SLN count by gamma probe (P = 0.01). Initial surgery, large loop excision of the transformation zone, or cone biopsy of the cervix had no effect on SLN count. There was no difference observed in bilateral detection with respect to surgical approach (open: n = 48/laparoscopic: n = 84). However, older age was independently associated with a decrease in bilateral SLN detection (P = 0.003). In these patients who underwent unilateral full pelvic lymphadenectomy, all the nonsentinel nodes were negative.


CONCLUSIONS
The majority of SLNs were located in the external iliac, obturator, and internal iliac regions. Both older age and an elevated body mass index were associated with a reduced SLN count. Unilateral detection of SLN was independently associated with older age, which may be due to sclerosis in the lymphatic vessels or reduced perfusion in the pelvis in these women. If no SLN is detected on one side, the consensus is to perform a full pelvic lymphadenectomy on that side of the pelvis.
Departments of *Gynaecological Oncology and †Histopathology, Maidstone Hospital, Kent Oncology Centre, Maidstone, Kent, United Kingdom.
Rekha
R
Wuntakal
Andreas John
AJ
Papadopoulos
Stephen Attard
SA
Montalto
Milica
M
Perovic
Michael
M
Coutts
Omer
O
Devaja
D000328:Adult; D000367:Age Factors; D000368:Aged; D001011:Aorta; D015992:Body Mass Index; D002277:Carcinoma / Q000556:secondary* / Q000601:surgery; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007084:Iliac Vein; D008161:Lumbosacral Region; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008207:Lymphatic Metastasis; D008751:Methylene Blue; D008875:Middle Aged; D009367:Neoplasm Staging; D009776:Obturator Nerve; D011300:Preoperative Care; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D013668:Technetium Tc 99m Aggregated Albumin; D015899:Tomography, Emission-Computed, Single-Photon; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
D004396:Coloring Agents; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid; D008751:Methylene Blue