Vol 92, No 8 (2021)
Research paper
Published online: 2021-04-08

open access

Page views 1339
Article views/downloads 786
Get Citation

Connect on Social Media

Connect on Social Media

Factors limiting the detection of sentinel lymph nodes in early-stage cervical cancer

Marcin Sniadecki1, Gina Minarji1, Szymon Wojtylak2, Ewa Wycinka3, Marcin Liro1, Jerzy Iskrzycki4, Dariusz Wydra1
Pubmed: 33844253
Ginekol Pol 2021;92(8):556-562.


Objectives: Sentinel lymph node detection (SLND) has not yet displaced lymphadenectomy, but it is a desired supplementary technique in cervical cancer surgery. The aim of our study was to identify the sources of SLND failure while performing the procedure by injecting blue dye (BD) into the cervix in cases of early-stage cervical cancer (ECC).
Material and methods: We analyzed 27 consecutive ECC patients (FIGO IA2–IB1) who underwent hysterectomy with SLND and systematic lymphadenectomy between October 2011 and June 2014. The main inclusion criterion was at least unilateral SLND by BD. Predictors of either unilateral or bilateral staining were identified using multinomial logit models and a decision tree.
Results: Overall, bilateral staining was achieved in nine patients (33%). Among the factors analyzed, BMI > 23.5 kg/m2 was the only factor negatively affecting the quality of SLND using BD (p < 0.02) in the univariable multinomial logit model. All patients with BMI < 23.5 kg/m2 and depth of invasion ≥ 15 mm had unilateral mapping.
Conclusions: Both obese and overweight patients are unlikely to achieve optimal SLN staining with BD alone. Although some possible reasons are discussed, we believe that further studies are needed to clarify the specific limitations of other dyes currently in use.

Article available in PDF format

View PDF Download PDF file


  1. López-De la Manzanara Cano C, Cordero García JM, Martín-Francisco C, et al. Sentinel lymph node detection using 99mTc combined with methylene blue cervical injection for endometrial cancer surgical management: a prospective study. Int J Gynecol Cancer. 2014; 24(6): 1048–1053.
  2. Cibula D, Oonk MHM, Abu-Rustum NR. Sentinel lymph node biopsy in the management of gynecologic cancer. Curr Opin Obstet Gynecol. 2015; 27(1): 66–72.
  3. Salvo G, Ramirez PT, Levenback CF, et al. Sensitivity and negative predictive value for sentinel lymph node biopsy in women with early-stage cervical cancer. Gynecol Oncol. 2017; 145(1): 96–101.
  4. Seong SJu, Park H, Yang KM, et al. Detection of sentinel lymph nodes in patients with early stage cervical cancer. J Korean Med Sci. 2007; 22(1): 105–109.
  5. Ferrandina G, Distefano M, Mascilini F, et al. Could lymphadenectomy be avoided in locally advanced cervical cancer patients administered preoperative chemoradiation? A large-scale retrospective study. Eur J Surg Oncol. 2017; 43(12): 2270–2276.
  6. Cibula D, Abu-Rustum NR, Dusek L, et al. Bilateral ultrastaging of sentinel lymph node in cervical cancer: Lowering the false-negative rate and improving the detection of micrometastasis. Gynecol Oncol. 2012; 127(3): 462–466.
  7. Jarruwale P, Huang KG, Benavides D, et al. Factors related to sentinel node identification in cervical cancer. Gynecology and Minimally Invasive Therapy. 2012; 1(1): 19–22.
  8. Kadkhodayan S, Hasanzadeh M, Treglia G, et al. Sentinel node biopsy for lymph nodal staging of uterine cervix cancer: a systematic review and meta-analysis of the pertinent literature. Eur J Surg Oncol. 2015; 41(1): 1–20.
  9. Sniadecki M, Wydra DG, Wojtylak S, et al. The impact of low volume lymph node metastases and stage migration after pathologic ultrastaging of non-sentinel lymph nodes in early-stage cervical cancer: a study of 54 patients with 4.2 years of follow up. Ginekol Pol. 2019; 90(1): 20–30.
  10. Tanaka T, Terai Y, Ashihara K, et al. The detection of sentinel lymph nodes in laparoscopic surgery for uterine cervical cancer using 99m-technetium-tin colloid, indocyanine green, and blue dye. J Gynecol Oncol. 2017; 28(2): e13.
  11. Gasparri M, Mueller M, Papadia A. Instead of feeling blue, go green! The Lancet Oncology. 2018; 19(10): 1273–1274.
  12. Buda A, Papadia A, Zapardiel I, et al. From Conventional Radiotracer Tc-99(m) with Blue Dye to Indocyanine Green Fluorescence: A Comparison of Methods Towards Optimization of Sentinel Lymph Node Mapping in Early Stage Cervical Cancer for a Laparoscopic Approach. Ann Surg Oncol. 2016; 23(9): 2959–2965.
  13. Buda A, Di Martino G, Vecchione F, et al. Optimizing Strategies for Sentinel Lymph Node Mapping in Early-Stage Cervical and Endometrial Cancer: Comparison of Real-Time Fluorescence With Indocyanine Green and Methylene Blue. Int J Gynecol Cancer. 2015; 25(8): 1513–1518.
  14. Querleu D. Laparoscopic radical hysterectomy: an ESGO statement. https://www.esgo.org/explore/council/laparoscopic-radical-hysterectomy-an-esgo-statement/ (26.06.2020).
  15. Tanner EJ, Sinno AK, Stone RL, et al. Factors associated with successful bilateral sentinel lymph node mapping in endometrial cancer. Gynecol Oncol. 2015; 138(3): 542–547.
  16. Eriksson AG, Montovano M, Beavis A, et al. Impact of Obesity on Sentinel Lymph Node Mapping in Patients with Newly Diagnosed Uterine Cancer Undergoing Robotic Surgery. Ann Surg Oncol. 2016; 23(8): 2522–2528.
  17. Cheng-Yen Lai J, Yang MS, Lu KW, et al. The role of sentinel lymph node biopsy in early-stage cervical cancer: A systematic review. Taiwan J Obstet Gynecol. 2018; 57(5): 627–635.
  18. Bedyńska M, Szewczyk G, Klepacka T, et al. Sentinel lymph node mapping using indocyanine green in patients with uterine and cervical neoplasms: restrictions of the method. Arch Gynecol Obstet. 2019; 299(5): 1373–1384.
  19. Di Martino G, Crivellaro C, De Ponti E, et al. Indocyanine green versus radiotracer with or without blue dye for sentinel lymph node mapping in stage >IB1 cervical cancer (>2 cm). J Minim Invasive Gynecol. 2017; 24(6): 954–959.
  20. Surasi DS, O'Malley J, Bhambhvani P, et al. 99mTc-Tilmanocept: A novel molecular agent for lymphatic mapping and sentinel lymph node localization. J Nucl Med Technol. 2015; 43(2): 87–91.