Sentinel Lymph Node Detection In
Patients With Cervical Cancer
Yasmina José Gutiérrez*, Laura Baquedano Mainar, Marta Lamarca Ballestero, Silvia Ortega Marcilla, Amparo Borque Ibañez and Miguel Ángel Ruiz Conde
Department of Gynecology, Miguel Servet University Hospital, Spain
Submission: October 10, 2018;Published: January 21, 2019
*Corresponding author: Yasmina José Gutiérrez, Department of Gynecology. Miguel Servet University Hospital, Spain.
How to cite this article: Yasmina J G, Laura B M, Marta L B, Silvia O M, et al. Sentinel Lymph Node Detection In
Patients With Cervical Cancer. Glob J
Reprod Med. 2019; 6(3): 555689. DOI:10.19080/GJORM.2019.06.555689.
We investigated the validity of sentinel lymph node (SLN) detection after radioactive isotope and/or blue dye injection in patients with cervical cancer. Between December 2013 and September 2018, 15 patients with cervical cancer FIGO stage I, II and II under went SLN detection during primary operation (radical laparoscopic hysterectomy) or in patients with non surgical stages to determine the condition of the nodes before radiotherapy. The detection rate of SLN was 100%. The false-positive rate was 0%. After the combined injection, the detection rate, especifcity, and positive predictive values were 100%. A mean of 2.7 pelvic SLNs were detected. We conclude that the combination of radioactively labeled albumin with blue dye allows successful detection of SLN in patients with cervical cancer. The clinical validity of this technique must be evaluated prospectively.
The current standard of care for women who will be diagnosed with cervical cáncer includes radical hysterectomy or trachelectomy and bilateral pelvic lymphadenectomy. For women with early-stage cervical cancer, lymph node status is the most important prognosticator of survival. However, the majority of these patients will not have lymph node metastases. For women with cervical cancer, ideally we would optimize the identification of positive lymph node spread in the minority of patients while limiting the morbidity of lymph node dissection for the majority of women who will ultimately have negative nodes. For that reason, there is significant interest in validating lymphatic mapping and sentinel node biopsy for women with this disease.
The sentinel lymph node is the first node that receives drainage from the primary tumor. Therefore, if the sentinel lymph node is negative for metastasis, the remaining lymph nodes in the nodal basin should also be free of tumor. The use of lymphatic mapping and sentinel lymph node biopsy was first described by Cabanas in 1977. In an effort to decrease complications associated with lymphadenectomy, improve detection of micrometastatic disease, and fine tune our lymphadenectomy anatomic templates, sentinel lymph node (SLN) techniques have been developed and extensively studied in many oncologic fields. As a result, SLN technique is now part of the standard treatment guidelines for the
management of breast cancer, melanoma, and more recently, it is
being recognized as a safe and reasonable approach in select cases of vulvar cancer [1,2].
The objective of our study is Introduce sentinel lymph node detection in patients with cervical cáncer in our center and participe in the validation of the technique in a multicentric way .
Between December 2013 and September 2018, 15 patients
with cervical cancer FIGO stage I, II and II underwent SLN detection
during primary operation (radical laparoscopic hysterectomy) or
in patients with non surgical stages to determine the condition
of the nodes before radiotherapy (Figure 4) [5,6]. In all cases a
lymphadenectomy was also performed in the same surgical
act because it was an unvalidadted technique (Figure 5). The
detection rate of SLN was 100%. The false-positive rate was 0 %.
After the combined injection, the detection rate, especifcity, and
positive predictive values were 100%. The sensitivity was 95%.
There were only two false-negatives discovered. However, in one
of these patients the positive node was found in a hemipelvis that
did not map. A mean of 2.7 pelvic SLNs were detected .
Multiple single institution studies have reported their
experience with sentinel lymph node biopsy in cervical cancer
patients. Though the type of tracer used in each of these studies
is widely variable, almost all of them describe excellent negative
predictive values, ranging from 88% – 100%. However, sensitivity
appears to be more inconsistent. The senticol study is the largest
multi-institutional trial of sentinel lymph node biopsy limited to
women with early stage cervical cancer. In this study, 139 women
with stage IA1 or IB1 cervical cancer underwent intracervical
injection with radiocolloid and blue dye followed by sentinel node
dissection and pelvic lymphadenectomy. The authors reported a
detection rate of 97.8% and a sensitivity of 92%. There were only two false-negatives discovered. The study concluded that sentinel
node mapping is a sensitive method for detecting lymph node
metastasis for women with early-stage cervical cancer .
However, opponents have voiced concern that some nodal
metastases may be missed if only the sentinel lymph nodes are
removed. A high sensitivity of sentinel lymph nodes (SLN) for
pelvic lymph node staging has been repeatedly shown in patients
with cervical cancer. However, since only SLN are evaluated by
pathologic ultrastaging, the risk of small metastases, including
small macrometastases and micrometastases, in non-SLN is
unknown. This can be a critical limitation for the oncological
safety of abandoning a pelvic lymphadenectomy. Mapping sentinel
lymph nodes is popular among gynecologist- oncologists, which
lead to having fewer side effects in patients who suffer from
cervical cancer. Thus, more researches are required to confirm
the total removal of lymph nodes in patients with sentinel lymph
nodes positive . The presence of an effective team (composed
of an expert gynecologist- oncologist and nuclear medicine
team) is an important factor to have a successful surgery with an
acceptable diagnostic power, less invasive operations, and better
Sentinel lymph node detection in patients with cervical
cáncer is a multidisciplinary procedure involving gynecologists,
pathologists and nuclear medicine. Until the validation of the
techinque, lymphadenectomy will be performed in the same
surgical act to all patients in order to obtain data on the reliability
of the procedure. According to the previous consensus, the defined
validation parameters are al least 95% of the sentinel node
identification rate and false-negative rate ≤5%. The validation of
the techinque will allow to avoid morbidity to patients with early
stages and to select patients with affected lymph nodes candidates
for radiochemoterapy without the need for radical pelvic surgery.