Abstract
ObjectivesSentinel lymph node (SLN) mapping may replace staging radical pelvic lymphadenectomy in women with early-stage cervical cancer. In a national multicenter setting, we evaluated SLN mapping in women with early-stage cervical cancer and investigated the accuracy of SLN mapping and FDG-PET/CT in tumors >20 mm. MethodsWe prospectively included women with early-stage cervical cancer from March 2017–January 2021 to undergo SLN mapping. Women with tumors >20 mm underwent completion pelvic lymphadenectomy and removal of FDG-PET/CT positive nodes. We determined SLN detection rates, incidence of nodal disease, sensitivity and negative predictive value (NPV) of SLN mapping, and the sensitivity, specificity, NPV, and positive predictive value (PPV) of FDG-PET/CT. ResultsWe included 245 women, and 38 (15.5%) had nodal metastasis. The SLN detection rate was 96.3% (236/245), with 82.0% (201/245) bilateral detection. In a stratified analysis of 103 women with tumors >20 mm, 27 (26.2%) had nodal metastases. The sensitivity of SLN mapping adhering to the algorithm was 96.3% (95% CI 81.0–99.9%) and the NPV 98.7% (95% CI 93.0–100%). For FDG-PET/CT imaging the sensitivity was 14.8% (95% CI 4.2–33.7%), the specificity 85.5% (95% CI 75.6–92.5%), the NPV 73.9% (95% CI 63.4–82.7%), and the PPV 26.7% (95% CI 7.8–55.1%). ConclusionsSLN mapping seems to be an adequate staging procedure in early-stage cervical cancer tumors ≤20 mm. In tumors >20 mm, SLN mapping is highly sensitive but demands full adherence to the SLN algorithm. We recommend completion pelvic lymphadenectomy in tumors >20 mm until the oncological safety is established. FDG-PET/CT for nodal staging of women with early-stage cervical cancer seems limited.
Highlights
Lymph node involvement is the main prognostic factor for recurrence and survival in women with early-stage cervical cancer [1]
To evaluate the success of Sentinel lymph node (SLN) mapping, we summarized the rate of lymph node metastases and the total and bilateral SLN detection rates
Our study expounds one of the main controversies of SLN mapping in women with cervical cancer; is SLN mapping accurate for cervical tumors larger than 20 mm [24]? The SENTIREC CERVIX study is, to our knowledge, the first prospective national study to investigate the accuracy of SLN mapping in a large homogeneous sample of women with early-stage cervical cancer and tumor size >20 mm on final pathology
Summary
Lymph node involvement is the main prognostic factor for recurrence and survival in women with early-stage cervical cancer [1]. Much of the available evidence on SLN mapping in women with early-stage cervical cancer relies on analyses of mixed patient populations with different risk profiles such as tumor size [6]. Fluorodeoxyglucosepositron emission tomography/computed tomography (FDG-PET/CT) may assist SLN mapping in detecting lymph node metastasis in these women. Previous studies have shown a high sensitivity and specificity of FDG-PET/CT to detect lymph node metastasis in women with cervical cancer compared with other imaging modalities [12,13,14]. This primarily applies to women with locally advanced disease [13]
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