Intraoperative sentinel node identification with Technetium-99m-labeled nanocolloid in patients with cancer of the uterine cervix: A feasibility study

Abstract

The objective of this study is to determine the feasibility of intraoperative lymphatic mapping in patients with cervical carcinoma. Patients with early-stage cervical cancer, scheduled to undergo a Wertheims radical hysterectomy and pelvic lymphadenectomy, were eligible for the study. Technetium-99-m-labeled nanocolloid was injected intracervically at two locations around the tumor 3–6 hours before the operation. Images were recorded immediately and 2.5 hours later using a gamma camera. During the operation sentinel nodes (SLN) were identified using a handheld or laparoscopic gamma-detection probe (Navigator, Auto-Suture). After resection of the SLNs a standard pelvic (and para-aortic) lymphadenectomy was performed. The results of the histopathology of SLNs and non-SLNs were compared. The procedure was well tolerated by 24 of 25 patients. One or more SLN could be identified in 21 out of 25 patients. In one patient who was preoperatively irradiated, in two patients who had had a cone biopsy, and in one patient without previous interventions, no SLN could be detected. The mean time for identification was 5 minutes. In 16 patients, pathologic examination showed no metastatic disease in both SLNs and non-SLNs, whereas metastases were found in the SLN in five patients (in one case only SLN involved, four cases SLN and respectively 3, 11, 22 and 31 other positive nodes). This study shows that identification of SLNs in cancer of the uterine cervix is feasible with preoperatively administered 99mTc-labeled nanocolloid. To date, no false negative SLNs have been found, but expansion of the study is necessary to determine possible clinical application of this new technique.

Sentinel node biopsy for lymph nodal staging of uterine cervix cancer: A systematic review and meta-analysis of the pertinent literature

“…Injection of mapping material is difficult in these cases and early reports showed sentinel node identification failure in these patients. 19 However, the pooled detection rate of patients with conization was 91% and conization should not be considered as a contraindication for sentinel node mapping.…”

Sentinel node detection with 99mTc phytate alone is satisfactory for cervical cancer patients undergoing radical hysterectomy and pelvic lymphadenectomy

“…Some authors [10,13,[20][21][22], but not Coutant et al [23], reported that prior conization did not increase failure rate of SLN identification. Martinez-Palones et al [13] pointed out that injection of 99m Tc-labeled nanocolloid and blue dye should be performed precisely in the peripheral area of the remaining cervix.…”

Factors related to sentinel node identification in cervical cancer

“…The radioactive materials that are preferably used in different countries always contain Technetium-compounds. The efficiency of most trials was reported similarly in that the combined vital blue dye and isotope material technique had a detection rate of more than 80% to nearly 100% 16e30 and appears to be superior to lymphoscintigraphy 16,21,28,31,32 or vital dye technique alone. 16,21,28,33,34 However, there are many studies that display satisfactory results from noncombined methods.…”