The sentinel node in cervical cancer: scintigraphy and laparoscopic gamma probe-guided biopsy

The sentinel node (SN) procedure has been proven to be a valuable technique in the staging and treatment of a number of solid tumours. We evaluated the feasibility of SN biopsy with a laparoscopic gamma probe and dye guidance in 34 patients with clinically localised cervical cancer. After peritumoural injection of 140 MBq 99mTc colloidal albumin, dynamic and late static images were obtained. Just before the laparoscopic procedure, blue dye was injected. Blue and radioactive lymph nodes were excised followed by a regular lymphadenectomy. Lymphoscintigraphy revealed 70 SNs in 50 basins during dynamic imaging and 83 SNs in 63 basins at late imaging. SNs were visualised in 97% of the patients, bilaterally in 30 and unilaterally in three. Seventy-four of the 105 radioactive lymph nodes that were excised laparoscopically were considered to be SNs, 53 being blue as well, and were sent for frozen section. Nine foci that had been seen on scintigraphy could not be found either intraoperatively or in the remaining lymphadenectomy specimen. Four blue nodes were excised in three of five basins that had shown no foci during scintigraphy. In 17 basins of 12 patients, tumour-positive lymph nodes were found. In one of them a micrometastasis was found in the hysterectomy specimen while the lymphadenectomy did not contain any metastases (sensitivity 92%). Based on SN histology, the treatment was altered in nine patients (26%). We conclude that laparoscopic SN biopsy is feasible in cervical cancer and may result in custom-designed treatment strategies with a reduction in morbidity.

[1]  E. Darai,et al.  Laparoscopic sentinel lymph node procedure using a combination of patent blue and radioisotope in women with cervical carcinoma , 2003, Cancer.

[2]  G. Sliutz,et al.  Sentinel node procedure in Ib cervical cancer: a preliminary series , 2001, British Journal of Cancer.

[3]  L. Cravello,et al.  Port site metastasis after laparoscopy for uterine cervical carcinoma , 2003, Surgical Endoscopy And Other Interventional Techniques.

[4]  J. Fiorica,et al.  Detection of sentinel lymph nodes with lymphazurin in cervical, uterine, and vulvar malignancies. , 1999, Southern medical journal.

[5]  C. Cohen,et al.  The Incidence of Port-Site Metastases in Gynecologic Cancers , 2004, JSLS : Journal of the Society of Laparoendoscopic Surgeons.

[6]  M R Segal,et al.  Radiological evaluation of lymph node metastases in patients with cervical cancer. A meta-analysis. , 1997, JAMA.

[7]  P. Mathevet,et al.  Laparoscopic assessment of the sentinel lymph node in early stage cervical cancer. , 2000, Gynecologic oncology.

[8]  W. Tjalma,et al.  Port-site recurrence following laparoscopic surgery in cervical cancer. , 2001, International journal of gynecological cancer : official journal of the International Gynecological Cancer Society.

[9]  A. Staudach,et al.  Prognostic factors in surgically treated stage ib-iib cervical carcinomas with special emphasis on the importance of tumor volume. , 2001, Gynecologic oncology.

[10]  T. Bandurski,et al.  Usefulness of lymphoscintigraphy and intraoperative gamma probe detection in the identification of sentinel nodes in cervical cancer , 2004, European Journal of Nuclear Medicine and Molecular Imaging.

[11]  D. González,et al.  A limited role for adjuvant radiotherapy after the Wertheim/Okabayashi radical hysterectomy for cervical cancer confined to the cervix. , 1999, Gynecologic oncology.

[12]  E. Darai,et al.  Laparoscopic sentinel node procedure in patients with cervical cancer. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[13]  I. Jacobs,et al.  Molecular quantification and mapping of lymph-node micrometastases in cervical cancer , 2001, The Lancet.

[14]  Umberto Veronesi,et al.  A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. , 2003, The New England journal of medicine.

[15]  R. Reznek,et al.  Role of MR imaging in the selection of patients with early cervical carcinoma for fertility-preserving surgery: initial experience. , 1999, Radiology.

[16]  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.

[17]  D. Larsimont,et al.  How ‘hot’ is the pathologically positive sentinel lymph node in breast cancer patients? , 2003, Nuclear medicine communications.

[18]  W. A. Little,et al.  Radical hysterectomy for invasive cervical cancer: A 25‐year prospective experience with the Miami technique , 1993, Cancer.

[19]  A. Alavi,et al.  PET imaging in gynecologic malignancies. , 2004, Radiologic clinics of North America.

[20]  P. V. van Diest,et al.  The implementation of the sentinel node biopsy as a routine procedure for patients with breast cancer. , 2000, Surgery.

[21]  Martin F. Mihm,et al.  A new American Joint Committee on Cancer staging system for cutaneous melanoma , 2000, Cancer.

[22]  P. Sevelda,et al.  First report of lymphatic mapping with isosulfan blue dye and sentinel node biopsy in cervical cancer. , 2000, Anticancer research.

[23]  E. Petru,et al.  Parametrial spread of cervical cancer in patients with negative pelvic lymph nodes. , 2002, Gynecologic oncology.

[24]  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.

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

[26]  F. Landoni,et al.  SENTINEL NODE DETECTION IN CERVICAL CANCER , 2003, International Journal of Gynecologic Cancer.

[27]  D. Querleu,et al.  Laparoscopic identification of sentinel lymph nodes in early stage cervical cancer: prospective study using a combination of patent blue dye injection and technetium radiocolloid injection. , 2003, Gynecologic oncology.

[28]  N. Sakuragi,et al.  Incidence and distribution pattern of pelvic and paraaortic lymph node metastasis in patients with stages IB, IIA, and IIB cervical carcinoma treated with radical hysterectomy , 1999, Cancer.

[29]  F. Landoni,et al.  Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer , 1997, The Lancet.

[30]  P. V. van Diest,et al.  Laparoscopic detection of sentinel lymph nodes followed by lymph node dissection in patients with early stage cervical cancer. , 2003, Gynecologic oncology.