Usefulness of preoperative lymphoscintigraphy in patients who undergo radical hysterectomy and pelvic lymphadenectomy for cervical cancer.

OBJECTIVE The purpose of this study was to assess the value of preoperative lymphoscintigraphy before intraoperative lymphatic mapping for sentinel lymph node identification during radical hysterectomy. STUDY DESIGN Fifty patients underwent intraoperative lymphatic mapping on our institutional review board-approved protocol. The location of sentinel lymph nodes that were found on lymphoscintigraphy and intraoperative lymphatic mapping were compared. RESULTS Fifteen of 21 patients (71%) with solitary sentinel lymph nodes that were found on lymphoscintigraphy had multiple sentinel lymph node basins found during the operation. Thirteen of 25 patients (52%) with unilateral sentinel lymph node basins that were found on lymphoscintigraphy had bilateral sentinel lymph nodes at intraoperative lymphatic mapping. Of 15 patients with 2 sentinel lymph node locations that were identified on lymphoscintigraphy, 12 patients (80%) had > or = 3 found during the operation. Of the sentinel lymph nodes that were located on the external iliac basin (n = 47) on lymphoscintigraphy, only 20 lymph nodes (43%) were found at that location during the operation. Concordance between the 2 methods was poor. Seven of the 9 patients with lymph node metastases had disease that was limited to the sentinel lymph nodes. CONCLUSION Preoperative lymphoscintigraphy adds little value over intraoperative lymphatic mapping for sentinel lymph node identification during radical hysterectomy.

[1]  R. Uren,et al.  Nuclear medicine aspects of melanoma and breast lymphatic mapping. , 2004, Seminars in oncology.

[2]  P. V. van Diest,et al.  Sentinel lymph node procedure is highly accurate in squamous cell carcinoma of the vulva. , 2000, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[3]  G. Scambia,et al.  A randomized study comparing retroperitoneal drainage with no drainage after lymphadenectomy in gynecologic malignancies. , 1997, Gynecologic oncology.

[4]  N. Yaegashi,et al.  Sentinel lymph node detection in early cervical cancer with combination 99mTc phytate and patent blue. , 2004, Gynecologic oncology.

[5]  Giuseppe Madeddu,et al.  Use of tomographic nuclear medicine procedures, SPECT and pinhole SPECT, with cationic lipophilic radiotracers for the evaluation of axillary lymph node status in breast cancer patients , 2004, European Journal of Nuclear Medicine and Molecular Imaging.

[6]  C. Muller,et al.  Intraoperative lymphatic mapping in cervix cancer patients undergoing radical hysterectomy: A pilot study. , 2000, Gynecologic oncology.

[7]  John F. Thompson,et al.  Patterns of lymphatic drainage from the skin in patients with melanoma. , 2003, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[8]  Kurt Schicho,et al.  SPECT-CT for topographic mapping of sentinel lymph nodes prior to gamma probe-guided biopsy in head and neck squamous cell carcinoma. , 2004, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[9]  Burke,et al.  Treatment Options in Stage IB Cervical Cancer: Radical Hysterectomy and Radiotherapy. , 1994, Seminars in radiation oncology.

[10]  D L Morton,et al.  Technical details of intraoperative lymphatic mapping for early stage melanoma. , 1992, Archives of surgery.

[11]  Paul J. van Diest,et al.  The sentinel node in cervical cancer: scintigraphy and laparoscopic gamma probe-guided biopsy , 2004, European Journal of Nuclear Medicine and Molecular Imaging.

[12]  A. Gil-Moreno,et al.  Total laparoscopic radical hysterectomy with intraoperative sentinel node identification in patients with early invasive cervical cancer. , 2005, Gynecologic oncology.

[13]  J. Scoazec,et al.  Sentinel lymph node biopsy is not accurate in predicting lymph node status for patients with cervical carcinoma , 2004, Cancer.

[14]  P. V. van Dam,et al.  Intraoperative sentinel node identification with Technetium-99m-labeled nanocolloid in patients with cancer of the uterine cervix: A feasibility study , 2002, International Journal of Gynecologic Cancer.

[15]  M. Deavers,et al.  Lymphatic mapping and sentinel node identification in patients with cervix cancer undergoing radical hysterectomy and pelvic lymphadenectomy. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[16]  R. Coleman,et al.  Intraoperative lymphatic mapping and sentinel node identification with blue dye in patients with vulvar cancer. , 2001, Gynecologic oncology.

[17]  K. McMasters,et al.  Preoperative lymphoscintigraphy for breast cancer does not improve the ability to identify axillary sentinel lymph nodes. , 2000, Annals of surgery.

[18]  E. Even-Sapir,et al.  Lymphoscintigraphy for sentinel node mapping using a hybrid SPECT/CT system. , 2003, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[19]  Mark C Kelley,et al.  Lymphatic mapping and sentinel lymphadenectomy for breast cancer. , 2004, American journal of surgery.