Experience with Sentinel Lymph Node Biopsy in Cervical Cancer Patients in Miguel Servet University Hospital Volume 2 - Issue 4

Yasmina José Gutiérreza*, Laura Baquedano Mainara, Marta Lamarca Ballesteroa, Silvia Ortega Marcillaa, Amparo Borque Ibañeza and Miguel Ángel Ruiz Condea

• A Department of Gynecology, Miguel Servet University Hospital, College of Medicine Zaragoza, Spain

Received: June 06, 2019;   Published: June 20, 2019

Corresponding author: Yasmina José Gutiérrez, Department of Gynecology, Miguel Servet University Hospital, College of Medicine Zaragoza, Spain

DOI: 10.32474/OAJRSD.2019.02.000141

Abstract PDF

The current standard of care for women who will be diagnosed with cervical cancer includes radical hysterectomy or trachelectomy and bilateral pelvic lymphadenectomy. For women with earlystage cervical cancer, lymph node status is the most important prognosticator of survival. However, the majority of these patients will not have lymph node metastases. For women with cervical cancer, ideally we would optimize the identification of positive lymph node spread in the minority of patients while limiting the morbidity of lymph node dissection for the majority of women who will ultimately have negative nodes. For that reason, there is significant interest in validating lymphatic mapping and sentinel node biopsy for women with this disease. The sentinel lymph node is the first node that receives drainage from the primary tumor. Therefore, if the sentinel lymph node is negative for metastasis, the remaining lymph nodes in the nodal basin should also be free of tumor. The use of lymphatic mapping and sentinel lymph node biopsy was first described by Cabanas in 1977. In an effort to decrease complications associated with lymphadenectomy, improve detection of micro metastatic disease, and fine tune our lymphadenectomy anatomic templates, sentinel lymph node (SLN) techniques have been developed and extensively studied in many oncologic fields. As a result, SLN technique is now part of the standard treatment guidelines for the management of breast cancer, melanoma, and more recently, it is being recognized as a safe and reasonable approach in select cases of vulvar cancer. The objective of our study is Introduce sentinel lymph node detection in patients with cervical cancer in our center and participle in the validation of the technique in a multicentric way [1].

Retrospective descriptive study of the cases of SLN in patients with cervical cancer operated in our center from December 2013 to December 2018. We describe the procedure in our hospital, University Hospital Miguel Sevet from Zaragoza, Spain. Our center is reference center of gynecological oncology of Aragon, Spain. The day before surgery 1mCi/0,5ml nanocoll Technetium 99m was applied into the cervix at 300, 600, 900, and 1200. (Figures 1-2). Blue dye injection (Patentblue) occurred intraoperatively into the cervix at the same locations. We use it only in cases where it is anticipated that the location of the node can be difficult. (Figure 3). Detector gamma probe for laparoscopy is used to perform intraoperative detection of sentynel lymph nodes. (Figures 4-5). All the information about the patients and their datum were transcribed to an information base computerize. We used Statistic Process Social Sciences (SPSS) 20.0 for Windows (Copyright© SPSS Inc., 2006. Licencia Universidad de Zaragoza) to statistical analyses during the study period [2,3].

Figure 1: Images of sentinel lymph nodes obtained by nuclear medicine.

Figure 2: Sentinel Lymph node localization

Figure 3: Cervical tumor previous intraoperatively Patentblue injection

Figure 4: Detector gamma probe for laparoscopy

Figure 5: Detector gamma probe for laparoscopy.

Between December 2013 and December 2018, 19 patients with cervical cancer FIGO stage I, II and II underwent SLN detection during primary operation (radical laparoscopic hysterectomy) or in patients with non-surgical stages to determine the condition of the nodes before radiotherapy. (Figures 6-8) show the process of detection of lymph node during surgery with or without the application of patent blue. In all cases a lymphadenectomy was also performed in the same surgical act because it was an unvalidated technique. The detection rate of SLN was 100%. The false-positive rate was 0 %. After the combined injection, the detection rate, specificity, and positive predictive values were 100%. The sensitivity was 95%. There were only two false negatives discovered. However, in one of these patients the positive node was found in a hemipelvis that did not map. A mean of 2.7 pelvic SLNs were detected. (Figure 9) shows anatomopathological study of sentinel lymph node [4-6].

Figure 6: Intraoperative identification of sentinel lymph node with patent blue.

Figure 7: Intraoperative identification of sentinel lymph node without patent blue

Figure 8: Removal of sentynel lymph node without patient blue.

Figure 9: Anatomopathological study of sentinel lymph node.