Sentinel lymph node biopsy is not accurate in predicting lymph node status for patients with cervical carcinoma

Abstract

BACKGROUNDThe authors evaluated the accuracy of sentinel lymph node biopsy in predicting lymph node status for patients with early cervical carcinoma. In particular, the authors set out to determine the false‐negative rate associated with sentinel lymph node biopsy in this setting.METHODSTwenty‐nine consecutive patients with early cervical carcinoma who were treated with pelvic laparoscopic lymphadenectomy and radical surgery underwent sentinel lymph node biopsy following lymphatic mapping with patent blue dye. All sentinel and nonsentinel lymph nodes were evaluated for micrometastases via multilevel sectioning followed by immunohistochemical staining.RESULTSAt least one sentinel lymph node was identified for each patient. On routine pathologic evaluation, 3 patients (10%) were found to have positive lymph nodes. Among the remaining 26 patients, multilevel sectioning in conjunction with immunohistochemical analysis identified 5 patients (19%) who had micrometastases in the pelvic lymph nodes. Two of these five patients had micrometastases in a sentinel lymph node; however, the more notable finding was that the other three patients had micrometastases in nonsentinel pelvic lymph nodes despite having negative findings on sentinel lymph node biopsy. Thus, the negative predictive value of sentinel lymph node biopsy in the current study was 87.5%.CONCLUSIONSMultilevel sectioning followed by cytokeratin immunohistochemistry may identify additional patients who have lymph node micrometastases; in the current study, this technique identified cases in which micrometastases were present in nonsentinel lymph nodes even when sentinel lymph nodes were found to be negative for disease on biopsy. This high false‐negative rate associated with sentinel lymph node biopsy, raises questions regarding the validity of the sentinel lymph node concept in cervical carcinoma. Cancer 2004. © 2004 American Cancer Society.

Molecular Diagnosis of Sentinel Lymph Node Metastases in Cervical Cancer Using Squamous Cell Carcinoma Antigen

“…Immunohistochemical staining for tumor markers improves the sensitivity of micrometastasis detection and, when combined with serial sectioning to reduce the sampling error, results in upstaging of a significant number of patients. Some studies (7,8) have shown that doing additional tissue sections and/or immunohistochemistry of lymph node increases metastases detection, whereas other studies (9 -11), including our previous study (12), found that immunohistochemistry could not increase the detection rate of lymph node metastases in cervical cancer.…”

The prognostic significance of micrometastases in node-negative squamous cell carcinoma of the vulva

“…There has been a case reported of recurrence after Time ( sentinel node dissection where subsequent analysis confirmed that the negative sentinel node did contain micrometastases (Tamussino et al, 2002). Marchiole et al (2004) found that three out of five patients with nodal micrometastases in cervical cancer had tumour cells in nonsentinel nodes despite having negative findings. The high false negative rate with sentinel node biopsy in cervical cancer raises concerns about the accurate identification of sentinel nodes in this condition, which is in stark contrast to vulval cancer where the identification of sentinel nodes has been extensively studied with a higher predictive value.…”

Fluorescence in Situ Hybridization Markers for Prediction of Cervical Lymph Node Metastases

“…The prediction of lymph node positivity will assist in developing adequate treatment options for patients since histologically undetectable micrometastases in the lymphatic system may account for cervical cancer recurrence. [27][28][29] Histological examinations are not infallible since examinations only comprise a small portion of lymph nodes, and estimates indicate that a pathologist has a 1% chance of detecting a micrometastatic focus within a three-tumor-cell diameter. 28,30 Gene amplification is a common mechanism for oncogene activation in tumorigenesis and gains on chromosomes 1q, 3q, and 5p are frequently observed in cervical cancer.…”