Feasibility and performance of lymphoscintigraphy in sentinel lymph node biopsy for early cervical cancer: results of the prospective multicenter SENTICOL study.

Anne-Sophie Bats,Marc Froissart,Isabelle Orliaguet,Khaldoun Kerrou,Patrice Mathevet,Slimane Zerdoud,Désirée Deandreis,Eric Leblanc,Denis Querleu,Fabrice Lecuru,Albane Frati,Emilie Lenain,Henri Marret,Emile Darai,Hélène Gauthier,Catherine Uzan

doi:10.1007/s12149-014-0910-1

Abstract

ObjectiveTo evaluate feasibility, SLN detection rate, and SLN location of lymphoscintigraphy in sentinel lymph node (SLN) biopsy for early cervical cancer.MethodsAncillary analysis of data from the multicenter prospective SENTICOL study (January 2005–June 2007) of patients with early cervical cancer (FIGO stage IA with emboli to IB1) was conducted. Preoperative lymphoscintigraphy was performed after intracervical administration of 60 or 120 MBq of 99mTc-labeled radiocolloid on the day before (long protocol) or morning of (short protocol) surgery. SLNs were identified intraoperatively using combined radioactivity/patent blue detection. SLNs were sampled electively and routine bilateral pelvic lymphadenectomy was performed by laparoscopy. A centralized review of lymphoscintigraphies was performed to assess feasibility, detection rates, and anatomic SLN location.ResultsOf 139 patients included in the SENTICOL study, 133 received radiocolloid injection, and 131 (98.5 %) underwent preoperative lymphoscintigraphy, with the long protocol in three-fourths of cases. The lymphoscintigraphic detection rate was 87.8 %, with a median of 2 (1–4) SLNs per patient. By multivariate analysis, factors independently associated with lymphoscintigraphic SLN detection were age [odds ratio (OR) 0.91, 95 % confidence interval (95 % CI) 0.87–0.96; P < 0.001], and protocol (long vs. short; OR 8.23, 95 % CI 1.87–36.25; P = 0.005). Bilateral SLN identification by lymphoscintigraphy occurred in 67 % of cases and was independently influenced by age (OR 0.95, 95 % CI 0.92–0.98, P < 0.001) and protocol (OR 5.42, 95 % CI 2.21–13.27; P < 0.001). Although 60.5 % of preoperative SLNs were in the external iliac territory, unusual drainage patterns included the common iliac (19.6 %), para-aortic (10.8 %), and parametrial (6 %) basins.ConclusionsOur study demonstrates the feasibility and good detection rate of preoperative lymphoscintigraphy, with better detection in younger patients and with the long protocol. The high proportion of SLN basins in unexpected territories is of interest to guide intraoperative detection. Further studies are needed to better evaluate preoperative detection and to assess the contribution of lymphoscintigraphy to intraoperative detection.

Highlights

The sentinel lymph node (SLN) biopsy procedure was developed to identify and analyze the first drainage nodes of solid tumors, whose status is representative of the nodes located further along the drainage pathway
The high proportion of SLN basins in unexpected territories is of interest to guide intraoperative detection
The feasibility of preoperative lymphoscintigraphy was assessed by collecting failures and complications

Summary

Introduction

The sentinel lymph node (SLN) biopsy procedure was developed to identify and analyze the first drainage nodes of solid tumors, whose status is representative of the nodes located further along the drainage pathway. A negative SLN biopsy indicates that complete lymphadenectomy is unnecessary, allowing a substantial decrease in surgical morbidity. The SLN technique, and preoperative lymphoscintigraphy, may help to detect aberrant drainage pathways and allows nodal ultrastaging, which is difficult to perform on a large number of nodes. Early cervical cancer seems a good candidate for the SLN technique. Nodal involvement is a major prognostic factor in early cervical cancer [1], but is present in less than 20 % of patients at this stage [2].

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