Change in clinical management of sentinel lymph node location in early stage cervical cancer: the role of SPECT/CT

• Published in: Gynecologic oncology 2011-03, Vol.120 (3), p.353-357
• Main Authors: Díaz-Feijoo, Berta, Pérez-Benavente, María A, Cabrera-Diaz, Silvia, Gil-Moreno, Antonio, Roca, Isabel, Franco-Camps, Silvia, Fernández, Mónica Sabaté, García-Jiménez, Angel, Xercavins, Jordi, Martínez-Palones, José M
• Format: Article
• Language: English
• Subjects: Adult; Aged; Female; Humans; Middle Aged; Neoplasm Staging; Prospective Studies; Sentinel Lymph Node Biopsy - methods; Tomography, Emission-Computed, Single-Photon - methods; Tomography, X-Ray Computed - methods; Uterine Cervical Neoplasms - mortality; Uterine Cervical Neoplasms - pathology
• ISSN: 1095-6859
• DOI: 10.1016/j.ygyno.2010.12.336

The aim of this study was to investigate the feasibility of the sentinel lymph node (SLN) identification with SPECT/CT lymphoscintigraphy imaging in the early stage invasive cervical cancer in patients undergoing radical hysterectomy and pelvic lymphadenectomy. Between March 2007 and June 2009, a prospective consecutive study was designed for SLN mapping. Twenty-two patients with cervical cancer FIGO stage IB1 (n=20) or stage IIA1 (n=2) underwent SLN identification with preoperative SPECT/CT and planar images (technetium-99m colloid albumin injection around the tumor) and posterior intraoperative detection with both blue dye and a handheld or laparoscopic gamma probe. Complete pelvic lymphadenectomy was performed in all cases by open (n=2) or laparoscopic (n=20) surgery. In the present series, a total of 35 SLN were detected with planar images and 40 SLN were identified and well located by SPECT/CT lymphoscintigraphy (median 2.0 nodes per patient). In 5/22 patients (22.7%) SPECT/CT procedure improves the number of localized SLN. Intraoperatively, 57 SLNs were identified, with a median of 3 SLNs per patient by gamma probe (a total of 53 hot nodes) and a median of 2 nodes per patient after blue dye injection (a total of 42 blue nodes). Microscopic nodal metastases (eight nodes, corresponding to four patients) were confirmed in 18.18% of cases; all these lymph nodes were previously detected as SLN. The remaining 450 nodes, including SLNs, following complete pelvic lymphadenectomy, were histologically negative. Sentinel lymph node detection is improved by SPECT/CT imaging because of the increased number of SLN detected and the better tridimensional anatomic location, allowing easier intra-operative detection with gamma probe and showing, in this series, a 100% negative predictive value.