Impact of micrometastasis or isolated tumor cells on recurrence and survival in patients with early cervical cancer: SENTICOL Trial

Guani, Benedetta; Dorez, M.; Magaud, Laurent; Buénerd, Annie; Lécuru, Fabrice; Mathevet, Patrice

doi:10.1136/ijgc-2018-000089

Cited by 55 publications

(35 citation statements)

References 17 publications

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“…This topic can be answered by currently ongoing prospective studies. 10,147,148 We believe that an ultrastaging protocol aimed at the detection of as many MICs and ITCs as possible should be favored over a more limited approach, until more data regarding their clinical significance are obtained. However, regarding the significance of ITCs, it would be difficult to gain data that would allow us to assess their prognostic meaning even from prospective trials.…”

Section: Discussionmentioning

confidence: 99%

“…However, most recurrences (11 of 13) occurred in LN-negative patients, and even the presence of MAC was not found to be a negative prognostic factor. 10 Also, SLNs are found elsewhere than in the external iliac region and obturator fossa in about 10% of cases. 5 In these cases, SLN detection can help to detect and remove the key LN that could be otherwise overlooked.…”

mentioning

confidence: 99%

“…8,9 Nonetheless, the published data are not uniform. Recently, a group of French authors 10 reviewed SLNs from 139 patients enrolled in their prospective trial and did not find a higher recurrence rate in cases with MICs. However, most recurrences (11 of 13) occurred in LN-negative patients, and even the presence of MAC was not found to be a negative prognostic factor.…”

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confidence: 99%

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Pathologic Protocols for Sentinel Lymph Nodes Ultrastaging in Cervical Cancer

Dundr

Cibula

Němejcová

et al. 2019

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Ultrastaging of sentinel lymph nodes (SLNs) is a crucial aspect in the approach to SLN processing. No consensual protocol for pathologic ultrastaging has been approved by international societies to date. Objective.— To provide a review of the ultrastaging protocol and all its aspects related to the processing of SLNs in patients with cervical cancer. Data Sources.— In total, 127 publications reporting data from 9085 cases were identified in the literature. In 24% of studies, the information about SLN processing is entirely missing. No ultrastaging protocol was used in 7% of publications. When described, the differences in all aspects of SLN processing among the studies and institutions are substantial. This includes grossing of the SLN, which is not completely sliced and processed in almost 20% of studies. The reported protocols varied in all aspects of SLN processing, including the thickness of slices (range, 1–5 mm), the number of levels (range, 0–cut out until no tissue left), distance between the levels (range, 40–1000 μm), and number of sections per level (range, 1–5). Conclusions.— We found substantial differences in protocols used for SLN pathologic ultrastaging, which can impact sensitivity for detection of micrometastases and even small macrometastases. Since the involvement of pelvic lymph nodes is the most important negative prognostic factor, such profound discrepancies influence the referral of patients to adjuvant radiotherapy and could potentially cause treatment failure. It is urgent that international societies agree on a consensual protocol before SLN biopsy without pelvic lymphadenectomy is introduced into routine clinical practice.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Pathologic Protocols for Sentinel Lymph Nodes Ultrastaging in Cervical Cancer

Dundr

Cibula

Němejcová

et al. 2019

Archives of Pathology &Amp; Laboratory Medicine

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“…As sentinel lymph node biopsy is becoming an accepted standard of care, we are faced with the conundrum of what the prognosis and appropriate management is for patients with early cervical cancer and small volume metastasis in the sentinel lymph node. A recent prospective study where patients underwent sentinel lymph node biopsy followed by confirmatory pelvic lymphadenectomy showed no impact on recurrence-free survival at 36 months; 12 of the 13 patients with small volume nodal disease did not receive any adjuvant treatment 9. Previous retrospective studies5 10–15 have included patients who had sentinel lymph node biopsy followed by pelvic lymphadenectomy, and have had conflicting results.…”

Section: Introductionmentioning

confidence: 99%

Does small volume metastatic lymph node disease affect long-term prognosis in early cervical cancer?

Nica

Gien

Ferguson

et al. 2019

Int J Gynecol Cancer

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IntroductionAs sentinel lymph node biopsy is evolving to an accepted standard of care, clinicians are being faced with more frequent cases of small volume nodal metastatic disease. The objective of this study is to describe the management and to measure the effect on recurrence rates of nodal micrometastasis and isolated tumor cells in patients with early stage cervical cancer at two high-volume centers.MethodsWe conducted a review of prospectively collected patients with surgically treated cervical cancer who were found to have micrometastasis or isolated tumor cells on ultrastaging of the sentinel lymph node. Our practice is to follow patients for ≥5 years post-operatively either at our center or another cancer center closer to home.ResultsNineteen patients with small volume nodal disease were identified between 2006 and 2018. Median follow-up was 62 months. Ten (53%) had nodal micrometastatic disease, while nine (47%) had isolated tumor cells detected in the sentinel lymph node. Seven patients (37%) underwent completion pelvic lymphadenectomy and four of them also had para-aortic lymphadenectomy; there were no positive non-sentinel lymph nodes. The majority (74%) received adjuvant treatment, mostly driven by tumor factors. We observed two recurrences. Recurrence-free survival was comparable with historical cohorts of node negative patients, and adjuvant treatment did not seem to impact the recurrence rate (p=0.5).ConclusionGiven the uncertainties around the prognostic significance of small volume nodal disease in cervical cancer, a large proportion of patients receive adjuvant treatment. We found no positive non-sentinel lymph nodes, suggesting that pelvic lymphadenectomy or para-aortic lymphadenectomy may not be of benefit in patients diagnosed with small volume nodal metastases. Recurrence-free survival in this group did not seem to be affected. However, given the small numbers of patients and lack of level 1 evidence, decisions should be individualized in accordance with patient preferences and tumor factors.

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“…After an average follow-up of 36 months the authors did not find a statistically significant difference in disease-free survival between patients with positive or negative lymph nodes (91.6% vs 90.4%, respectively; p=0.49). Among patients with SLNs positive for micrometastases (eight patients), only one had a recurrence 20. However, the authors themselves admit that their study was insufficiently powered to allow them to draw conclusions about the safety of omitting full lymph node dissection and/or adjuvant treatment in patients with micrometastases.…”

Section: Discussionmentioning

confidence: 98%

Frozen section examination of sentinel lymph nodes can be used as a decisional tool in the surgical management of early cervical cancer

Rychlik

Ángeles

Croce

et al. 2020

Int J Gynecol Cancer

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IntroductionSentinel lymph node (SLN) detection has been shown to be accurate in detecting lymph node involvement in early-stage cervical cancer. The objective of this study was to evaluate the accuracy of frozen section examination in the assessment of SLN status, with the aim of adequately driving the intra-operative decision.MethodsWe designed a retrospective study including patients from two comprehensive cancer centers between January 2001 and December 2018 with early-stage cervical cancer (IA1-IB2 according to International Federation of Gynecology and Obstetrics (FIGO) 2018) undergoing SLN dissection. The SLN procedure was performed using a cervical injection with technetium-99m combined with blue dye or indocyanine green in most cases.ResultsA total of 176 patients fulfilled inclusion criteria. Bilateral mapping was detected in 153 (86.7%) of them. Nineteen of these patients (12.4%) had SLN involvement: 13 with macrometastases, three with micrometastases and three with isolated tumor cells (ITC). Macrometastatic disease was missed on frozen section in 3/13 FIGO 2018 stage IIIC patients. The three patients with ITC were also missed by frozen section examination.Considering only macrometastases as lymph node involvement, frozen section sensitivity was 76.9% (95% CI 49.7 to 91.8) and negative predictive value (NPV) was 97.9% (95% CI 94.0 to 99.3) in patients with bilateral detection. Including micrometastases, sensitivity was 81.2% (95% CI 57.0 to 93.4) and NPV remained at 97.9% (95% CI 93.9 to 99.3).ConclusionsWith a prevalence of final-stage IIIC in patients with pre-operative early-stage cervical cancer of the order of 10% in this series, the NPV of frozen section examination of SLN is very high, with an inferior limit of the CI superior to 94%. Diagnostic accuracy remains acceptable even if micrometastases are considered. The impact of missed ITC has not been established. Frozen section examination can be incorporated in the intra-operative decision algorithm.

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Impact of micrometastasis or isolated tumor cells on recurrence and survival in patients with early cervical cancer: SENTICOL Trial

Cited by 55 publications

References 17 publications

Pathologic Protocols for Sentinel Lymph Nodes Ultrastaging in Cervical Cancer

Pathologic Protocols for Sentinel Lymph Nodes Ultrastaging in Cervical Cancer

Does small volume metastatic lymph node disease affect long-term prognosis in early cervical cancer?

Frozen section examination of sentinel lymph nodes can be used as a decisional tool in the surgical management of early cervical cancer

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