Identyfikacja węzla wartowniczego w inwazyjnym raku szyjki macicy: 5 lat doświadczeń

Abstract

Author(s): DARIUSZ WYDRA, SAMBOR SAWICKI, JANUSZ EMERICH

Introduction: In some present protocols the benefit of the sentinel node (SLN) procedure for the patient is the avoidance of overtreatment and reduction of morbidity.

Objectives: The aim of this study was to determine the feasibility of sentinel lymph node identification using radioisotopic lymphatic mapping with technetium-99m labelled nanocolloid and blue dye injection in patients with early-stage cervical cancer during 5 years of experiences.

Material and methods: 150 patients with FIGO stage IB1 to IIA primary carcinoma undergoing radical hysterectomy with pelvic lymphadenectomy were investigated. Results. At least one SN was found in 85,3% on one side and in 66% on both sides. The sentinel detection rate according to the stages was as follows: unilaterally IB1-97,8%, IB2-66,7%, IIA-62,5% and bilaterally 86%, 33,3%, 33,3%. Successful identification of SLN was less likely in patients with tumors >20 cm (58,5 % of SLN) compared with those with tumors =2 cm (95,4 % of SN). The false negative rate for the SLN procedure was 3,3% (5/150). In all false negative SLNs the primary cervical tumour was above 2 cm and there was an isthmus infiltration.

Conclusion: Sentinel node mapping for cervical cancer patients undergoing primary surgical therapy is a feasible option. The sentinel node detection rate is relatively high and depends on FIGO stage and the tumour size. Where a decision is made to refrain from surgery in favour of radiochemiotherapy, the detection of SN in cervical cancer would seen to be very suitable as part of the strategy in deciding treatment. We believe that in the near future we are likely to perform less aggressive surgery in cases of negative SLN, however SLN should be evaluated per side. It is recognized that before SLN biopsy becomes a routine procedure there needs to be some improvement in detection rates and analysis of the results.

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