Abstract
6028 Background: Sentinel lymph node biopsy (SLN) could be an alternative to systematic lymphadenectomy in early cervical cancer. SLN is less morbid and had shown a high sensitivity for metastasis detection. However, sensitivity of the SLN technique could be over evaluated because SLN are examined with ultrastaging and non sentinel nodes are only examined with routine techniques. The aim of this study was to validate the negative predictive value (NPV) of the SLN technique, with ultrastaging of SLN and non sentinel nodes (NSLN). Methods: We used the SENTICOL 1 study data, published in 2011. All nodes, SLN and NSLN have been secondarily subjected to ultrastaging. The ultrastaging consisted in sectioning every 200 µm and immunohistochemistry. A central reviewing of the positive slides and 10% of the negative slides was undertaken. Results: One hundred thirty-nine patients were included. SLNs were detected in 136 (97.8%) of the 139 patients. SLNs were found bilaterally in 104 (76.5%) of the 136 patients. 2056 NSLNs were identified (median = 13 NSLNs per patient [range 1-54]). Of 136 patients with SLNs detection, 23 had positive SLNs, after serial sectioning and IHC. NSLNs were metastatic in 8 patients. However, in case of bilateral SLN detection, the FN rate was 1/99 (1%) with detection of ITC in one NSLN from 99 bilateral negative SLNs. The NPV was 99% (0,99 [IC 95% = 0,97-1,00]). Conclusions: The pelvic SLN technic is a safe and trustfully technic to determine the nodal status in patients with early-stage cervical cancer. In case of optimal mapping with bilateral detection, NPV is 99% (IC 95% = 0,97-1,00).
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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