Sentinel lymph node biopsy in early-stage cervical cancer: Utility of intraoperative versus postoperative assessment

Fader, A. Nickles; Edwards, Robert P.; Cost, Marilyn; Kanbour‐Shakir, Amal; Kelley, Joseph L.; Schwartz, Benjamin; Sukumvanich, Paniti; Comerci, John T.; Sumkin, Jules H.; Elishaev, Esther; Rohan, Lisa C.

doi:10.1016/j.ygyno.2008.06.009

Cited by 86 publications

(53 citation statements)

References 21 publications

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“…The data in the literature on the diagnostic value of SLN frozen-section examination vary, with reported sensitivity ranging from 33 to 100%, depending on the technique used [14,15]. Martínez et al [16] investigated the accuracy of frozen SLN section in 94 patients with stage IA-IB1 cervical cancer who underwent SLN detection followed by full pelvic dissection.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the authors concluded that intraoperative frozen examination of SLNs accurately predicts the metastatic status of the lymph nodes. However, the sensitivity of frozen-section examination and imprint cytology is reportedly less than ideal for micrometastases and isolated tumor cells [11,14,17,18]. In addition, the procedure used to incise the SLNs affects the results of pathological examination.…”

Section: Discussionmentioning

confidence: 99%

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Value of Intraoperative Cytological and Pathological Sentinel Lymph Node Diagnosis in Fertility-Sparing Trachelectomy for Early-Stage Cervical Cancer

et al. 2017

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Background and Objectives: Trachelectomy, a fertility-sparing surgery for early-stage cervical cancer, can be performed only when there is no extrauterine extension present. Therefore, identifying the sentinel lymph nodes (SLNs) and using them to obtain an intraoperative pathologic diagnosis can provide information on the feasibility and safety of trachelectomy. Our aim was to assess the value of an intraoperative SLN diagnosis. Methods: We retrospectively analyzed the accuracy of intraoperative imprint cytology and frozen-section examination in 201 patients at our institution in whom trachelectomy was planned. Results: All patients could be evaluated for SLNs; a total of 610 SLNs were analyzed. Although the specificity of both imprint cytology and frozen-section examination was 100.0%, the sensitivity was only 58.6 and 65.5%, respectively. The diagnostic sensitivity was higher in 2-mm slices along the short axis than on bisection along the longitudinal axis. Imprint cytology correctly diagnosed 2 patients who had false-negative results on frozen section. The nature of the metastatic foci that caused an intraoperative false-negative diagnosis was either micrometastasis or isolated tumor cells. Conclusions: The accuracy of intraoperative SLN diagnosis requires improvement, especially when small metastatic foci are present.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Value of Intraoperative Cytological and Pathological Sentinel Lymph Node Diagnosis in Fertility-Sparing Trachelectomy for Early-Stage Cervical Cancer

et al. 2017

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“…Despite large studies have demonstrated a good diagnostic performance of SLN biopsy in cervical cancer patients, with a NPV ranging from 94.3% to 98.2%, one of the main concerns about its full adoption is the relatively low detection rate of the technique 11, 13, 20, 21, 22. As a matter of fact, looking at the official international literature, the frequency of a correct SLN identification really varies from one approach used to another and from a working team to another.…”

Section: Discussionmentioning

confidence: 99%

Beyond sentinel node algorithm. Toward a more tailored surgery for cervical cancer patients

et al. 2016

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Nowadays cervical cancer is frequently diagnosed at early stage. For these patients lymph node metastasis (LNM) is considered the most important prognostic factor. During the last decade many efforts have been made to reduce rate of complications associated with lymphadenectomy (LND). A great interest has arisen in sentinel lymph node (SLN) biopsy as a technique able to decrease number of LND performed and, at the same time, to assess lymph nodal status. High diagnostic performances have been reached thanks to SLN surgical algorithm. However, despite the efforts, about 25% of these patients undergo at least unilateral LND to meet NCCN recommendations. Data of women with International Federation of Gynecology and Obstetrics stage IA1‐IB1/IIA1 cervical carcinoma were retrospectively collected by six Italian institutions. All patients underwent complete preoperative staging workup and were primarily treated by radical hysterectomy and pelvic bilateral LND. A total of 368 patients with early‐stage cervical cancer were identified. Among them 333 (90.5%) showed no suspicious enlarged nodes at the preoperative magnetic resonance imaging (MRI). In this subset, tumor diameter ≥20 mm was the only independent predictor of LN status (P = 0.003). None of the 106 patients with negative MRI nodal assessment, with squamous and adenosquamous histotype and a tumor diameter less than 2 cm had LNM. Based on these results we propose a new modified SLN surgical algorithm that could safely reduce LND performed in patients with very low‐risk early‐stage cervical cancer.

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“…The similar result was found in the O'Boyle et al 33 study, which elucidated that 73% (11/15 patients) of sentinel node detection in tumor size 4.0 cm and 20% (one of five patients) in tumors >4.0 cm in diameter. They noticed that the larger volumetric tumor may disturb lymphatic channel drainage, decreasing SLN identification rate 29,33 and skipping node metastasis 29 can be occurred. Other similar studies were reported the same.…”

Section: Cervical Tumor Size Affects Sln Detectionmentioning

confidence: 99%

Factors related to sentinel node identification in cervical cancer

Jarruwale

Huang

Benavides

et al. 2012

Gynecology and Minimally Invasive Therapy

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a b s t r a c tCervical cancer remains a common malignancy in women. Lymph node is one of the significant important prognostic factors. Until now, there is no reliable investigative study that can evaluate nodal status the same as the International Federation of Gynecology and Obstetrics (FIGO) clinical staging system. Radical hysterectomy and pelvic lymphadenectomy is still one option in the standard treatment of patients with early-stage cervical cancer that can reveal metastatic lymph node but which can also produce treatment-related morbidities and complications. Sentinel lymph node identification has become a valuable technique for nodal status assessment. If lymph node metastasis was identified early, then unnecessary invasive surgical operations and complications may be avoided. IntroductionThe third most common female malignancy is cervical cancer; 530,000 new cases were diagnosed in 2008 1 and 250,000 deaths from it occurred in 2005, approximately 80% of deaths happened in developing countries. 2 Cervical cancer is still the fifth leading cause of cancer death (9.1 per 100,000) of women in Taiwan. 3 Nodal status is the most significant negative prognostic factor of cervical cancer and may also reveal the lymphatic spreading. 4 Likely as radical hysterectomy accompanied with pelvic lymphadenectomy still have the role in early stage cervical cancer treatment. If the risk factors of the lymphatic metastasis were identified, surgery may be skipped to another appropriate modality primarily. 5 Even though significant morbidity possibly occurred if extensive surgical procedures were performed. According to operative disadvantages, many studies were progressed for decreasing those adverse effects. Basis of sentinel lymph node detectionSentinel lymph node (SLN) was defined as the first node in regional lymphatic basin that receives primary lymphatic drainage. 6,7 If SLN does not emerge, the remaining regional nodes should also be free of metastases. Thus SLN identification was an alternative resource for avoiding unnecessary lymphadenectomy and surgical interventions. The SLN concept is not only generated from many studies for nongynecologic tumors, such as penile cancer, 8 breast cancer, 9 and melanoma, 10,11 but it was also utilized for gynecologic malignancy treatment 12,13 thereafter. Nowadays, the practical lymphatic mapping methods use vital blue dye and lymphoscintigraphy techniques. 6,7,14 The modes for SLN identification are labeled as "hot" and/or "blue" as shown in Fig. 1. Types of materials and trial proceedings were selected dissimilarly. Materials used for detecting SLNThere are various reporting methods for SLN detection, e.g., vital blue dye and radioactive isotopes in single or a combined technique. 6,15 The three most commonly used vital dyes are isosulfan blue, patent blue violet, and methylene blue by injection intradermally 5e10 mm in depth around the primary cervical tumor, avoiding tumoral or intravascular infusion directly to avoidance of high background signal intensity that can decline S...

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Sentinel lymph node biopsy in early-stage cervical cancer: Utility of intraoperative versus postoperative assessment

Cited by 86 publications

References 21 publications

Value of Intraoperative Cytological and Pathological Sentinel Lymph Node Diagnosis in Fertility-Sparing Trachelectomy for Early-Stage Cervical Cancer

Value of Intraoperative Cytological and Pathological Sentinel Lymph Node Diagnosis in Fertility-Sparing Trachelectomy for Early-Stage Cervical Cancer

Beyond sentinel node algorithm. Toward a more tailored surgery for cervical cancer patients

Factors related to sentinel node identification in cervical cancer

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