Abstract
Cervical cancer is currently the second most common form of neoplasia worldwide and third in the female population. Dissemination can occur directly (isthmus, parametrium, vagina, urinary bladder and/or rectum), through the lymphatic system (parametrium, internal iliac, external iliac, common iliac, obturator lymph nodes and rarely in the inferior gluteus, superior gluteus, superior rectum, sacrum, aortic lymph nodes) and through the circulatory system (lung, mediastinum, bones, liver). The risk of pelvic lymph nodes invasion in stage IB (FIGO) is 9-17%. The standard surgical treatment, for stages IA2-IIA, is radical hysterectomy with pelvic lymphadenectomy. The risk of intraoperative (vessel or nerve damage) or postoperative complications (lymphedema) is not negligible. The sentinel node concept refers to the first lymph node in which the cancerous lymphatic drainage takes place. This idea has radically changed the therapeutic approach in the treatment of breast cancer and melanoma. In cervical cancers, this technique is 92% accurate with only an 8% false negative rate. Currently, the sentinel node protocol is not included in the standard treatment for cervical cancer because certain issues need to be addressed (the sensitivity of the frozen section examination, the pathologist’s subjectivity, the uniformity of the protocol, the surgical experience, the size of the tumor).
Highlights
Cervical cancer is currently the second most common form of neoplasia worldwide and third in the female population
Radical hysterectomy with pelvic lymphadenectomy is the standard treatment for early stage cervical cancer
The results of this study showed that sentinel nodes were detected in 86.9% of early-stage cervical cancer cases and in 80% of the locally advanced cervical cancer cases
Summary
Cervical cancer is currently the second most common form of neoplasia worldwide and third in the female population. The study included 211 patients with early stage cervical cancer, in which surgery was performed laparoscopically to identify and remove the sentinel node, followed by systematic pelvic lymphadenectomy with or without paraaortic lymph node sampling. A systematic review of the literature on the benefit of sentinel node biopsy in the assessment of lymph node status in cervical cancer and which technique is best (vital dye, Tc -99m or combined method) was conducted and the results were presented in an article that included 842 patients. A retrospective multicenter study evaluated the false-negative rate of sentinel lymph node ultrastaging in patients with FIGO stages I-IIB cervical cancer. The authors reported a sensitivity of the technique (using either vital dye alone or in combination with radioisotope) of 97%with a false-negative rate of 1.3% for patients with bilaterally detected sentinel nodes. Challenges to adoption include the sensitivity of frozen section, availability of pathologic expertise, uniformity of technique, surgical experience, and clinical impact of tumor size [46]
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