Feasibility and performance of lymphoscintigraphy in sentinel lymph node biopsy for early cervical cancer: results of the prospective multicenter SENTICOL study

Abstract

ObjectiveTo evaluate feasibility, SLN detection rate, and SLN location of lymphoscintigraphy in sentinel lymph node (SLN) biopsy for early cervical cancer.MethodsAncillary analysis of data from the multicenter prospective SENTICOL study (January 2005–June 2007) of patients with early cervical cancer (FIGO stage IA with emboli to IB1) was conducted. Preoperative lymphoscintigraphy was performed after intracervical administration of 60 or 120 MBq of 99mTc-labeled radiocolloid on the day before (long protocol) or morning of (short protocol) surgery. SLNs were identified intraoperatively using combined radioactivity/patent blue detection. SLNs were sampled electively and routine bilateral pelvic lymphadenectomy was performed by laparoscopy. A centralized review of lymphoscintigraphies was performed to assess feasibility, detection rates, and anatomic SLN location.ResultsOf 139 patients included in the SENTICOL study, 133 received radiocolloid injection, and 131 (98.5 %) underwent preoperative lymphoscintigraphy, with the long protocol in three-fourths of cases. The lymphoscintigraphic detection rate was 87.8 %, with a median of 2 (1–4) SLNs per patient. By multivariate analysis, factors independently associated with lymphoscintigraphic SLN detection were age [odds ratio (OR) 0.91, 95 % confidence interval (95 % CI) 0.87–0.96; P < 0.001], and protocol (long vs. short; OR 8.23, 95 % CI 1.87–36.25; P = 0.005). Bilateral SLN identification by lymphoscintigraphy occurred in 67 % of cases and was independently influenced by age (OR 0.95, 95 % CI 0.92–0.98, P < 0.001) and protocol (OR 5.42, 95 % CI 2.21–13.27; P < 0.001). Although 60.5 % of preoperative SLNs were in the external iliac territory, unusual drainage patterns included the common iliac (19.6 %), para-aortic (10.8 %), and parametrial (6 %) basins.ConclusionsOur study demonstrates the feasibility and good detection rate of preoperative lymphoscintigraphy, with better detection in younger patients and with the long protocol. The high proportion of SLN basins in unexpected territories is of interest to guide intraoperative detection. Further studies are needed to better evaluate preoperative detection and to assess the contribution of lymphoscintigraphy to intraoperative detection.

Location of Sentinel Lymph Node in Cervical Carcinoma and Factors Associated With Unilateral Detection

“…No SLN was found in the upper para-aortic region, and this was similar to that reported by Martínez et al 11 The detection of SLN in the presacral region was seen in 4 patients (3%), which was comparable to that reported in the SENTICOL study. 4 Despite detailed examination of the histological specimens, no involved nodes were identified in the parametrial region in 108 patients, unlike in the SENTICOL study. 4,13,27 The main challenge in identifying SLNs in this region is the very high signal originating from the primary cervical site because of its close proximity.…”

“…Few studies have reported the SLN locations by different methods of detection (SPECT/CT scan, gamma probe, and blue dye). 4,11,12,27,28 These studies describe overall SLN locations in different regions of the pelvis, but not all commented on laterality.…”

“…The therapeutic effect of lymphadenectomy is still controversial, but it is important with respect to prognosis and selection of patients for adjuvant therapy. 4,5 However, postoperative morbidity can be significant in terms of leg lymphoedema and lymphocyst formation in up to 20% to 30% of patients. 6Y9 In an attempt to reduce the surgical morbidity associated with a full pelvic lymphadenectomy, the sentinel lymph node (SLN) procedure has been proposed as a surgical alternative.…”

“…11,12,15Y20 The negative predictive value has been reported to be 97% to 100%. 4,12,15,17,21Y24 Several studies have described the anatomical location of the SLN in the pelvis in cervical cancer 4,10Y12 but not separately for each hemipelvis, and only a few have examined the potential factors associated with unilateral detection. This study reports the intraoperative anatomical SLN locations detected separately for each hemipelvis and examines the factors affecting bilateral detection.…”

Contribution of lymphoscintigraphy to intraoperative sentinel lymph node detection in early cervical cancer: Analysis of the prospective multicenter SENTICOL cohort

“…The feasibility of lymphoscintigraphy, and the factors associated with preoperative detection have been reported elsewhere [16].…”