The sentinel node concept in early cervical cancer performs well in tumors smaller than 2 cm

ObjectiveThe aim of the study was to evaluate the sentinel node (SLN) concept for lymphatic mapping in early stage cervical cancer.Methods105 women with early stage (1a1–2a) cervical cancer were scheduled for the sentinel node procedure in conjunction with a complete pelvic lymphadenectomy. The day before surgery, 1–1.5 mL 120MBq Tc99 albumin nanocolloid was injected submucosally at four points around the tumor followed by a lymphoscintigram (LSG) to achieve an overview of the radiotracer uptake.ResultsDuring surgery, the overall detection rate (gamma probe) of at least one SLN was 90% (94/105 women) whereas at least one SLN was identified in 94% (61/65 women) with a tumor ≤ 2 cm. Bilateral SLNs were identified in 62/105 (59%) of the women.Among 18 women with any metastatic lymph node 17 had a metastatic SLN (sensitivity 94%, 95% CI 73–100%). Among 61 women with a tumor ≤ 2 cm, all five women with any metastatic lymph node also had a metastatic SLN (sensitivity 100%). One woman with a 1.5-cm squamous epithelial carcinoma had metastatic positive SLNs on each side but also one metastatic bulky (>2 cm) node without radiotracer uptake. The negative predictive value for patients with cervical cancers ≤ 2 cm was 100%.ConclusionsThe SLN-technique seems to be an accurate method for identifying lymph node metastases in cervical cancer patients with tumors of 2 cm or smaller. In case of a unilateral SLN only, a complete lymphadenectomy should be performed on the radionegative side. All bulky nodes must be removed.