title: Beyond sentinel node algorithm. Toward a more tailored surgery for cervical cancer patients.
abstract: Nowadays cervical cancer is frequently diagnosed at early stage. For these patients lymph node metastasis (LNM) is considered the most important prognostic factor. During the last decade many efforts have been made to reduce rate of complications associated with lymphadenectomy (LND). A great interest has arisen in sentinel lymph node (SLN) biopsy as a technique able to decrease number of LND performed and, at the same time, to assess lymph nodal status. High diagnostic performances have been reached thanks to SLN surgical algorithm. However, despite the efforts, about 25% of these patients undergo at least unilateral LND to meet NCCN recommendations. Data of women with International Federation of Gynecology and Obstetrics stage IA1-IB1/IIA1 cervical carcinoma were retrospectively collected by six Italian institutions. All patients underwent complete preoperative staging workup and were primarily treated by radical hysterectomy and pelvic bilateral LND. A total of 368 patients with early-stage cervical cancer were identified. Among them 333 (90.5%) showed no suspicious enlarged nodes at the preoperative magnetic resonance imaging (MRI). In this subset, tumor diameter ≥20 mm was the only independent predictor of LN status (P = 0.003). None of the 106 patients with negative MRI nodal assessment, with squamous and adenosquamous histotype and a tumor diameter less than 2 cm had LNM. Based on these results we propose a new modified SLN surgical algorithm that could safely reduce LND performed in patients with very low-risk early-stage cervical cancer.
authors.affiliation: Division of Minimally Invasive Gynaecology, St. Maria Hospital, University of Perugia, Terni, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Fagotti
authors.affiliation: Gynecologic Oncology Unit, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Pedone Anchora
authors.affiliation: Gynecologic Oncology Unit, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Conte
authors.affiliation: Division of Gynecologic Oncology, Department of Oncology, Foundation John Paul II, Catholic University of the Sacred Heart, Campobasso, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Chiantera
authors.affiliation: Gynecology Oncology Unit, Department of Oncological Surgery, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Vizza
authors.affiliation: Gynecologic Oncology Unit, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Tortorella
authors.affiliation: Department of Obstetrics and Gynecology, University of Eastern Piedmont, Novara, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Surico
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, S. Orsola Hospital, University of Bologna, Bologna, Italy.
authors.forename: Pierandrea
authors.initials: P
authors.lastname: De Iaco
authors.affiliation: Gynecology Oncology Unit, Department of Oncological Surgery, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Corrado
authors.affiliation: Gynecologic Oncology Unit, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fanfani
authors.affiliation: Gynecologic Oncology Unit, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Gallotta
authors.affiliation: Gynecologic Oncology Unit, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D000071036:Sentinel Lymph Node / Q000473:pathology*; D021701:Sentinel Lymph Node Biopsy; D019564:Unnecessary Procedures; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Cervical cancer; early stage; lymphadenectomy; sentinel lymph node