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

A. Nickles Fader, R. P. Edwards, M. Cost, A. Kanbour-Shakir, J. L. Kelley, B. Schwartz, P. Sukumvanich, J. Comerci, J. Sumkin, E. Elishaev, L. Cencia Rohan

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)13-17
Number of pages5
JournalGynecologic oncology
Volume111
Issue number1
DOIs
StatePublished - Oct 1 2008
Externally publishedYes

Keywords

  • Cervical cancer
  • Sentinel lymph node
  • Sentinel lymph node detection in cervical cancer

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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  • Cite this

    Fader, A. N., Edwards, R. P., Cost, M., Kanbour-Shakir, A., Kelley, J. L., Schwartz, B., Sukumvanich, P., Comerci, J., Sumkin, J., Elishaev, E., & Rohan, L. C. (2008). Sentinel lymph node biopsy in early-stage cervical cancer: Utility of intraoperative versus postoperative assessment. Gynecologic oncology, 111(1), 13-17. https://doi.org/10.1016/j.ygyno.2008.06.009