Abstract
This study aimed to assess the accuracy of predicting pelvic lymph node status using sentinel lymph node (SLN) biopsy with indocyanine green (ICG) and to examine the outcomes of SLN biopsy-guided abdominal radical trachelectomy (ART). Patients with stage IA2–IB2 cervical cancer from January 2009 to January 2021 were included. ICG was injected before ART and SLNs were identified, excised, and assessed intraoperatively using fast-frozen sections. Systemic pelvic lymphadenectomy was subsequently performed. The SLN detection rate, sensitivity, and false-negative rate were determined. Thirty patients desiring fertility preservation were enrolled, of whom 26 successfully completed ART and four underwent radical hysterectomies because of metastatic primary SLNs. Bilateral SLNs were identified in all patients. The sensitivity, false-negative rate, and negative predictive value were 100%, 7.7%, and 92.3%, respectively. Three (12%) patients were lost to follow-up: two relapsed and one died of tumor progression. Of the nine patients who tried to conceive after surgery, four achieved pregnancy and three delivered healthy live infants. In women with early-stage cervical cancer who desired to conserve fertility, SLN mapping with ICG had a very high detection rate, sensitivity, and low false-negative rate. SLN biopsy-guided ART is a feasible and accurate method for assessing pelvic node status.
Highlights
Cervical cancer is the fourth most commonly diagnosed cancer in women, with 604,000 new cases diagnosed annually, and the number of relatively young patients diagnosed in the early stages of this cancer is increasing [1,2]
We aimed to evaluate the accuracy and prognosis of sentinel lymph node (SLN) mapping surgery using indocyanine green (ICG) as a guide for abdominal radical trachelectomy (ART) for early cervical cancer
Young patients who were diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IA2–IB2 cervical cancer and were scheduled to undergo ART at the Kyoundo Hospital from January 2009 to August 2021 were enrolled in this study
Summary
Cervical cancer is the fourth most commonly diagnosed cancer in women, with 604,000 new cases diagnosed annually, and the number of relatively young patients diagnosed in the early stages of this cancer is increasing [1,2]. According to GLOBOCAN 2020, there were 12,785 new patients with cervical cancer and 4213 deaths across all ages in Japan in 2020 [3]. This incidence is almost twice that of countries with higher cervical screening levels such as Australia [3]. As of September 2021, proactive recommendation for HPV vaccines remains suspended. If this vaccine hesitancy crisis continues, 9300–10,800 preventable cervical cancer deaths will occur over the 50 years (2020–2069) in Japan [8]
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