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

• Published in: Gynecologic oncology 2008-10, Vol.111 (1), p.13-17
• Main Authors: Fader, A. Nickles, Edwards, R.P, Cost, M, Kanbour-Shakir, A, Kelley, J.L, Schwartz, B, Sukumvanich, P, Comerci, J, Sumkin, J, Elishaev, E, Rohan, L. Cencia
• Format: Article
• Language: English
• Subjects: Cervical cancer; Female; Frozen Sections; Hematology, Oncology and Palliative Medicine; Humans; Immunohistochemistry; Intraoperative Care - methods; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Neoplasm Staging; Obstetrics and Gynecology; Postoperative Care - methods; Radionuclide Imaging; Rosaniline Dyes; Sentinel lymph node; Sentinel Lymph Node Biopsy - methods; Sentinel lymph node detection in cervical cancer; Technetium Tc 99m Sulfur Colloid; Uterine Cervical Neoplasms - diagnostic imaging; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2008.06.009

Abstract Objective To determine the diagnostic accuracy of sentinel lymph node (SLN) detection using lymphoscintigraphy, intraoperative blue dye, and radiocolloid in patients with early-stage cervical cancer. Methods Intra-cervical injection of technetium-99 sulfur colloid and lymphoscintigraphy were performed preoperatively. Isosulfan blue was injected intra-cervically immediately prior to surgery. SLNs were excised and examined intraoperatively (imprint cytology and frozen section) and postoperatively (H and E histology and immunohistochemistry (IHC) for cytokeratin). Results Thirty eight patients were evaluable. Laparoscopy and laparotomy were performed in 28.9% and 71.1%, respectively. Subjects had squamous cell carcinoma ( n = 26), adenocarcinoma ( n = 10) or adenosquamous ( n = 2) histologies. 55.3% had cervical tumors < 2 cm. The overall SLN detection rate was 92.1%. The external iliac region just distal to the common iliac bifurcation was the most common SLN location. A mean of 2.1 SLNs were detected per patient with bilateral SLNs observed in 47.4%. On final pathology, metastatic nodal disease was identified in 15.7% of patients. Of these, 83.3% were detected in the SLNs. Sensitivity of SLN detection of metastasis was 100% for patients with cervical tumors < 2 cm. However intraoperative evaluation by imprint cytology and frozen section correctly identified lymph node metastasis in only 33.3%. Conclusions SLN detection is feasible and accurately reflects pelvic nodal basin status when performed in early-stage cervical cancer patients. However, while current intraoperative pathology techniques for assessing nodal metastases reliably detect metastases larger than 2 mm, they lack sufficient sensitivity to detect micrometastasis and isolated tumor cells.