A GCIG international survey: clinical practice patterns of sentinel lymph node biopsies in cervical cancer

Gf, Vercellino; Erdemoğlu, Evrim; Lichtenberg, Pesach; Muallem, Mustafa Zelal; Richter, Rolf; Nr, Abu-Rustum; Plante, Marie; Lécuru, Fabrice; Greggi, Stefano; Bj, Monk; Sagae, Satoru; Denkert, Carsten; Keller, Maren; Malak, Al-Hakeem; Hellriegel, Martin; Am, Dückelmann; Chiantera,; Sehouli, Jalid

doi:10.1007/s00404-019-05164-2

Cited by 19 publications

(14 citation statements)

References 42 publications

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“…The diagnostic value of SLN technique has been verified by previous studies, with a meta-analyzed sensitivity of 91.4% in early-stage cervical cancer [16]. However, no consensus has been achieved on the management subsequent to SLN biopsy [13]. In the latest FIGO staging system for cervical cancer, patients with lymphatic metastasis are classified as stage IIIC and should be treated with concurrent chemoradiotherapy [17].…”

Section: Discussionmentioning

confidence: 93%

“…In clinical practice, some gynecologists are still used to perform systematic lymphadenectomy for patients with positive SLN identified on intraoperative assessment [12], whereas others directly exempt lymphadenectomy for all patients and plan chemoradiotherapy for those presenting positive SLN on final pathology. A recent international survey by the Gynecologic Cancer Intergroup clearly reflected these divergences in gynecologists' attitudes toward SLN biopsy [13]. Evidence remains lacking to resolve these divergences and it is unclear how much risks will be taken if lymphadenectomy was completely replaced by SLN biopsy.…”

Section: Introductionmentioning

confidence: 99%

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Potential risks in sentinel lymph node biopsy for cervical cancer: a single-institution pilot study

Wan

Zhang

et al. 2020

World J Surg Onc

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Background: Sentinel lymph node (SLN) biopsy is an attractive technique that is widely performed in many oncological surgeries. However, the potential risks in SLN biopsy for cervical cancer remains largely unclear. Methods: Seventy-five patients with histologically confirmed cervical cancer were enrolled between May 2014 and June 2016. SLN biopsies were performed followed by pelvic lymphadenectomies and all resected nodes were labeled according to their anatomic areas. Only bilateral detections of SLNs were considered successful. Patients' clinicopathologic feature, performance of SLN detection, and distributions of lymph node metastases were analyzed. Results: Of the 75 enrolled patients, at least one SLN was detected in 69 (92.0%), including 33 in bilateral and 36 in unilateral. SLNs were most detected in the obturator area (52 of 69 patients, 75.4%) and 26 (37.7%) patients presented SLNs in more than one area of hemipelvis. Lymphovascular invasion was found to be the only factor that adversely influenced SLN detection, while the tumor diameter, growth type, histological grade, deep stromal invasion, and neoadjuvant chemotherapy showed no significant impacts. Patients with lymphovascular invasion showed a significantly higher rate to have unsuccessful detection (90.9% versus 41.5%, P < 0.001) and lymph node metastasis (40.9% versus 3.8%, P < 0.001) compared with those without. Nodal metastases were confirmed in 11 patients, of whom 9 (81.8%) had lymphovascular invasion and 7 (63.6%) had non-SLN metastasis. The most frequently involved SLNs were obturator nodes (9/11, 81.8%). In addition, the parametrial nodes also have a high rate to be positive (4/11, 36.4%), although they were relatively less identified as SLNs. Besides, 3 patients showed metastases in the laterals without SLN detected. Conclusions: In cervical cancer, lymphovascular invasion is a significant factor for unsuccessful SLN detection. The risk of having undetected metastasis is high when SLN is positive; therefore, further lymphadenectomy may be necessary for these patients.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Potential risks in sentinel lymph node biopsy for cervical cancer: a single-institution pilot study

Wan

Zhang

et al. 2020

World J Surg Onc

View full text Add to dashboard Cite

show abstract

“…The diagnostic value of SLN technique has been veri ed by previous studies, with a meta-analyzed sensitivity of 91.4% in early-stage cervical cancer [16]. However, no consensus has been achieved on the management subsequent to SLN biopsy [13]. In the latest FIGO staging system for cervical cancer, patients with lymphatic metastasis are classi ed as stage IIIC and should be treated with concurrent chemoradiotherapy [17].…”

Section: Discussionmentioning

confidence: 99%

Potential risks in sentinel lymph node biopsy for cervical cancer: a single-institution pilot study

Wan

Zhang

et al. 2020

Preprint

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Background：Sentinel lymph node (SLN) biopsy is an attractive technique that widely performed in many oncological surgeries. However, the potential risks in SLN biopsy for cervical cancer remains largely unclear. Methods：Seventy-five patients with histologically confirmed cervical cancer were enrolled between May 2014 and June 2016. SLN biopsies were performed followed by pelvic lymphadenectomies and all resected nodes were labeled according to their anatomic areas. Only bilateral detections of SLNs were considered as successful. Patients’ clinicopathologic feature, performance of SLN detection, and distributions of lymph node metastases were analyzed. Results: Of the 75 enrolled patients, at least one SLN was detected in 69 (92.0%), including 33 in bilateral and 36 in unilateral. SLNs were most detected in obturator area (52 of 69 patients, 75.4%) and 26 (37.7%) patients presented SLNs in more than one area of hemipelvis. Lymphovascular invasion was found to be the only factor that adversely influenced SLN detection, while the tumor diameter, growth type, histological grade, deep stromal invasion and neoadjuvant chemotherapy showed no significant impacts. Patients with lymphovascular invasion showed significantly higher rate to have unsuccessful detection (90.9% versus 41.5%, P<0.001) and lymph node metastasis (40.9% versus 3.8%, P<0.001) compared with those without. Nodal metastases were confirmed in 11 patients, of whom 9 (81.8%) had lymphovascular invasion and 7 (63.6%) had non-SLN metastasis. The most frequently involved SLNs were obturator nodes (9/11, 81.8%). In addition, the parametrial nodes also has high rate to be positive (4/11, 36.4%), although they were relatively less identified as SLNs. Besides, 3 patients showed metastases in the laterals without SLN detected.Conclusions: In cervical cancer, lymphovascular invasion is a significant factor for unsuccessful SLN detection. The risk of having undetected metastasis is high when SLN is positive, therefore further lymphadenectomy may be necessary for these patients.

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“…Für die intraoperative Schnellschnittuntersuchung von Sentinel-Lymphknoten bei gynäkologischen Malignomen gibt es keine allgemeingültigen Richtlinien [24,32,[48][49][50].…”

Section: Schnellschnittuntersuchungunclassified

Leitlinienbasierte Aufarbeitung und Befundung von Lymphonodektomiepräparaten und Sentinel-Lymphknoten gynäkologischer Malignome

et al. 2020

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Entsprechend der UICC-und TNM-Klassifikation sind Mikrometastasen definiert als der histologische Nachweis von Tumorzellen im Lymphknoten von ≥0,2 mm, aber nicht größer als 0,2 cm. Tumorzellen von <0,2 mm Gesamtausdehnung werden als isolierte Tumorzellen im Lymphknoten definiert [41, 51]. Infobox 1 Dokumentation von isolierten Tumorzellen und von Mikrometastasen Der Nachweis von isolierten Tumorzellen bzw. von Mikrometastasen soll im histologischen Befundbericht erwähnt werden und in die TNM-Klassifikation einfließen.

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A GCIG international survey: clinical practice patterns of sentinel lymph node biopsies in cervical cancer

Cited by 19 publications

References 42 publications

Potential risks in sentinel lymph node biopsy for cervical cancer: a single-institution pilot study

Potential risks in sentinel lymph node biopsy for cervical cancer: a single-institution pilot study

Potential risks in sentinel lymph node biopsy for cervical cancer: a single-institution pilot study

Leitlinienbasierte Aufarbeitung und Befundung von Lymphonodektomiepräparaten und Sentinel-Lymphknoten gynäkologischer Malignome

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