Sentinel node in gynaecological cancers. Our experience

Abstract

Although sentinel lymph node (SLN) identification is widely used in melanoma and breast cancer some concerns exist in other malignancies, such as gynaecologic cancers, and this staging method has not been adopted in many centers due to lack of large validation studies. Aim To evaluate the applicability and results of SLN technique in gynaecological malignancies regarding our institution. Method We studied 155 patients with different malignancies (70 vulvar, 50 cervical and 35 endometrial cancers). The day before surgery a lymphoscintigraphy was performed by injecting 111 MBq of 99mTc- nanocolloid in several ways depending on the type of cancer studied. Intraoperative detection of the SLN was always performed by using a hand-held gammaprobe and in 100 cases with the aid of blue dye injection (70 vulvar and 30 in cervical cancer) a few minutes before surgical intervention. The pathology study of SLN was performed in all cases. Lymphadenectomy was done in all cervix and endometrial cancer patients and in the first 35 vulvar cancer patients. Results Pre-surgical lymphoscintigraphy demonstrated at least one SLN in 97% of vulvar cancer patients, 92% in the cervical malignancy and 64% in the endometrial cancer patients. During surgery, SLN was harvested in 97%, 90% and 62% of patients, respectively. The pathology study showed metastases in 24.2%, 8.8 and 4.5% of patients with vulvar, cervical and endometrial cancer, respectively. The false negative percentage was 5.5% in vulvar cancer patients, with 2 cases in the endometrial cancer and without any case in the cervical cancer patients. Conclusion Lymphoscintigraphy is a relatively simple and useful technique to identify the SLN in this kind of tumours. However, in endometrial cancer more effort has to be made to reach a suitable result. Sentinel lymph node biopsy seems to be a reliable technique in vulvar and cervical malignancies.