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

Abstract

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.

Diagnostic value of frozen section examination of sentinel lymph nodes in early-stage cervical cancer at the time of ultrastaging

“…A non-negligible proportion of macrometastase was also missed intraoperatively in our study (7/47; 14.9%) and was similar to that reported by Slama et al of 16.7% [10]. However, in other studies, detection of macrometastases reached 100% of sensitivity by FSE [12,13]. This point raises the question of the technique of SLN cutting.…”

“…In our study, SLNs were cut in half along the long axis and the both parts were analysed after HE staining in FSE. Instead of simply bisected the SLN, slicing 2-mm intervals the SLN along the short axis may increase the accuracy of intraoperative SLN examination [13,14]. This improvement was underlined in the study of Gortzak-Uzan et al who reported that metastases were detected intraoperatively in 11 out 14 cases, even if most of them were small macrometastases (8/11) [24].…”

“…The accuracy of frozen section pathologic examination (FSE) of SLNs is a key-question, and is debated because of limits for the detection of low-volume metastases such as ITCs and micrometastases [10][11][12][13][14][15].…”

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

“…Of note, a Japanese study found a higher diagnostic sensitivity when using 2 mm slicing along the short axis and combining the method with imprint cytology. For both methods, the sensitivity, accuracy and NPV were 65.5%, 98.3%, and 98.3%, respectively 10. An interesting argument in favor of frozen section examination was pointed by Casarin et al, in the setting of SLN biopsy in endometrial cancer patients.…”

“…These encouraging results are confirmed in the present study. A recent study by Sonoda et al reported the results of 210 patients undergoing the SLN procedure in the setting of fertility-sparing treatment, with 100% sensitivity for macrometastases when 2 mm slicing for SLN was used 10. In addition, the accuracy of frozen section examination in SLN was also studied in endometrial cancer patients.…”