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SENTINEL LYMPH NODES IN CERVICAL CANCER
Isabel RocaHU VALL HEBRON
The sentinel lymph node mappingand surgical biopsy
is anEMERGING TECHNIQUE
in early stages of cervical cancer
SENTINEL LYMPH NODE DETECTION IN EARLY STAGES OF CERVICAL CANCER
The purpose of thisstudy is
to describe theusefulness
andclinical impact
of this techniquein early stages
of cervical cancer
1- Detection rate of SLN in early stages
2- Predictive value of SLN for lymphatic spread3- Does the SLN detection improve the clinical management ?4- Describe the anatomic localization of the SLN
SENTINEL LYMPH NODE DETECTION IN EARLY STAGES OF CERVICAL CANCER
AIMS
CERVICAL CANCER CERVICAL CANCER REGIONAL LYMPH NODE REGIONAL LYMPH NODE
INVOLVEMENT INVOLVEMENT
HAICH KD , 1994
Stage I 0 - 16 % 0 - 22 %
Stage II 24,5- 31 % 11 - 19 %
pelviclymph node +
paraaorticlymph node +
LYMPHOEDEMALYMPHOCYST
NORMAL LYMPH NODE RESSECTION:NEGATIVE FOR IMMUNITY AND FOLLOW-UP
IN EARLY STAGES > 90% RESSECTED LYMPH NODES
WILL BE NEGATIVE Schneider A. et al (2001)
CERVICAL CANCERCERVICAL CANCERADVERSE EFFECTSADVERSE EFFECTS
PELVIC AND AORTIC LYMPHADENECTOMYPELVIC AND AORTIC LYMPHADENECTOMY
Emerging technique:
� 26 papers 1999-2005
� 13 2004-2005
SENTINEL NODE IN EARLY SENTINEL NODE IN EARLY STAGES OF CERVICAL CANCERSTAGES OF CERVICAL CANCER
REFERENCES
SENTINEL LYMPH NODE
TUMOUR
The SLN will be the
first involved lymph node in case of
lymphatic spread
LYMPHOSCINTIGRAPHYLYMPHOSCINTIGRAPHYIN CERVICAL CANCERIN CERVICAL CANCER
TECHNIQUE:• 99mTc nanocolloid• 4 injeccions• 0,2 ml• around the tumour
LYMPHOSCINTIGRAPHYLYMPHOSCINTIGRAPHYIN CERVICAL CANCERIN CERVICAL CANCER
post injection images
10-30 minutes
2-4 hours
LYMPHOSCINTIGRAPHYLYMPHOSCINTIGRAPHYIN CERVICAL CANCERIN CERVICAL CANCER
First visualized
lymph node
Lymph node with higher
activity
LYMPHOSCINTIGRAPHY :LYMPHOSCINTIGRAPHY :sentinelsentinel lymphlymph nodenodeIDENTIFICATIONIDENTIFICATION
isosulfan Blue-Dye 1% 4 injeccions
preanaestesic time same locations
GROUP OF STUDYN = 40
GROUP OF STUDYN = 40
FIGO stages N %IA2 2 5IB1 34 85IB2 1 2.5IIA 3 7.5
HISTOLOGY N %Squamous 25 62.5Adenocarcinoma 12 30Leiomyosarcoma 1 2.5Indifferenciated 1 2.5Neuroendocrine 1 2.5
PREVIOUS CONIZATION N %
YES 18 45NO 22 55
SURGICAL APPROACH N %
Laparotomy 28 70 Laparoscopy 12 30
Hot SLN or Blue DyeSurgery
Number of patients
37 37 35 40
No drainage 3 3 2 0
N SLN 79 83 70 99
Mean 2.14 2.24 2 2.48
Lympho scintigraphy
Hot SLN Surgery
Blue Dye Surgery
HOT and BLUE
HOT only BLUE only
Common Iliac 8 3 5 1 9Presacral 3 - - 3Interiliac 26 14 9 49External Iliac 12 6 1 19Obturator 8 1 4 13Parametrial 2 1 1 4TOTAL 79 54 29 16 99
LYMPHO SCINTIGRAPHY
SURGERY TOTAL
Aortic bifurcation2 2
N patients
69
- 2 -
SLN non-SLNSLN + 6 68aSLN - 93 666aTOTAL 99 734
ª all negative
TP 6
TN 93
FP 0
FN 0
SLN detection
SENTINEL LYMPH NODE DETECTION
HUVH Series N = 40
90 % 10 % 0 %
1- Detection rate of SLN in early stages100 %
2- Predictive value of SLN for lymphatic spread0% false negative in the first 40 cases
3- Does the SLN detection improve the clinical management ?N= 40 100% detection (combining isotope and blue dye)0% false negative
⇒ validation of the technique4- Describe the anatomic localization of the SLN+++ interiliac region
5% aortic bifurcation / paraaortic
CONCLUSIONSCONCLUSIONS
5. In early stages of cervical cancer, thelymphoscintigraphy with the surgical sentinellymph node detection is a useful techniquewhich can be incorporated to the clinicalpractice, both with laparotomy or by laparoscopic approach.
6.0% false negative in this series of 40 patients:• High NPV
7.SLN detection in non-usual locations
CONCLUSIONSCONCLUSIONS