Abstract
BackgroundThe sentinel lymph node (SLN) biopsy may be an alternative to systematic lymphadenectomy in early cervical cancer. The SLN biopsy is less morbid and has been shown to have high sensitivity for metastasis detection. However, the sensitivity of the SLN technique might be overevaluated because SLNs are examined with ultra-staging, and non-sentinel nodes usually are examined only with routine techniques. This study aimed to validate the negative predictive value (NPV) of the SLN technique by the ultra-staging of SLNs and non-sentinel nodes (NSLNs).MethodsThe SENTICOL 1 study data published in 2011 were used. All nodes (i.e., SLNs and NSLNs) were secondarily subjected to ultra-staging. The ultra-staging consisted of sectioning every 200 µm, in addition to immunohistochemistry. Moreover, the positive slides and 10% of the negative slides were reviewed.ResultsThe study enrolled 139 patients, and SLNs were detected in 136 (97.8%) of these patiets. Bilateral SLNs were detected in 104 (76.5%) of the 136 patients. A total of 2056 NSLNs were identified (median, 13 NSLNs per patient; range 1–54). Of the 136 patients with SLNs, 23 were shown to have positive SLNs after serial sectioning and immunohistochemical staining. The NSLNs were metastatic in six patients. In the case of bilateral SLN detection, the NPV was 100%, with no false-negatives (FNs).ConclusionsThe pelvic SLN technique is safe and trustworthy for determining the nodal status of patients with early-stage cervical cancer. In the case of optimal mapping with bilateral detection, the NPV was found to be 100%.
Highlights
The sentinel lymph node (SLN) biopsy may be an alternative to systematic lymphadenectomy in early cervical cancer
Consecutive patients were prospectively enrolled for evaluation of the SLN technique with a double-labeling method as follows: Isotopic method 1⁄4 Nanocis injection Colorimetric method 1⁄4 Patent Blue injection: We included adults with cervical carcinoma who met the International Federation of Gynecology and Obstetrics (FIGO) 2009 criteria for stage 1A1 disease with lymphovascular space invasion and stage 1B1 disease with squamous, adenocarcinoma, or adenosquamous histology
Two patients with a history of cancer were excluded, and four patients left the study before the SLN detection procedure
Summary
The sentinel lymph node (SLN) biopsy may be an alternative to systematic lymphadenectomy in early cervical cancer. The SLN biopsy is less morbid and has been shown to have high sensitivity for metastasis detection. The sensitivity of the SLN technique might be overevaluated because SLNs are examined with ultrastaging, and non-sentinel nodes usually are examined only with routine techniques. This study aimed to validate the negative predictive value (NPV) of the SLN technique by the ultra-staging of SLNs and non-sentinel nodes (NSLNs). All nodes (i.e., SLNs and NSLNs) were secondarily subjected to ultra-staging. The study enrolled 139 patients, and SLNs were detected in 136 (97.8%) of these patiets. Bilateral SLNs were detected in 104 (76.5%) of the 136 patients. Of the 136 patients with SLNs, 23 were shown
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