open access

Vol 9, No 1 (2006)
Short communications
Published online: 2006-01-25
Submitted: 2012-01-23
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Detection of sentinel lymph nodes in cervical cancer. A comparison of two protocols

Otakar Kraft, Libor Ševcík, Jaroslav Klát, Peter Koliba, Romuald Curík, Hana Kríožvá
Nucl. Med. Rev 2006;9(1):65-68.

open access

Vol 9, No 1 (2006)
Short communications
Published online: 2006-01-25
Submitted: 2012-01-23

Abstract

BACKGROUND: The aim of this study was lymphatic mapping to identify SLN in cervical cancer (CaCerv) with radioactive colloids, intraoperative detection with patent blue dye (PBD) and gamma probe (GP) and biopsy and comparison of two protocols.
MATERIAL AND METHODS: In 54 patients with CaCerv before hysterectomy and lymph nodes dissection (LND) we performed preoperative lymphoscintigraphy utilizing 99mTc-colloid (Nanocoll, SentiScint or Nanocis), activity 40 MBq, on the operation day (30 women) or the day before operation (24 women). Gynaecologists injected 4 peritumoural injections of colloid into the cervix around the tumour. Scintigraphy followed 25-50 minutes (one-day protocol) or 12-19 hours (two-day protocol) after injection. Gynaecologists also injected 4 peritumoural injections of PBD into the cervix around the tumour. All women underwent SLN biopsy and LND (in average 35 lymph nodes were taken) and hysterectomy. SLNs (active and/or blue lymph nodes) were examined by a pathologist [histopathology and immunohistochemistry (IH) with detection of cytokeratine]. No SLN was examined without IH.
RESULTS: The gynaecologists withdrew 123 SLNs (on average 2.27/1 patient) and in total 1898 lymph nodes (on average 35/1 patient). In 1 woman the tumour was inoperable. Two-day protocol, which involved scintigraphy, PBD and GP detected SLNs on both sides (45 SLNs) in 17 women (70.8%), SLNs on the one side (6 SLNs) in 3 patients (12.5%) and no SLNs were found in 4 women (16.7%). One-day protocol detected SLNs on both sides in 23 patients (74.1%) - 63 SLNs, in 7 women on one side (25.9%) - 9 SLNs. Metastases in SLNs (with or without metastases in other LN) were found in 21 patients (38.9%) - in 1 woman of stage FIGO IB1, in 1 woman of stage FIGO IB2, in 1 patient of stage FIGO IIIA and in all 18 patients of stage FIGO IIIB. False negative SLN detection was 0%.
CONCLUSIONS: In SLN detection in patients with CaCerv, all 3 methods - scintigraphy, PBD and GP - should be used, and the success rate of SLN detection increases, although scintigraphy has lower significance than in SLN detection in malignant melanoma and breast cancer. One-day protocol had a better detection rate of SLN than two-day protocol. The method is promising but its results are not as unequivocal and optimistic as in breast cancer and malignant melanoma, and it is still experimental. Additional experience is necessary.

Abstract

BACKGROUND: The aim of this study was lymphatic mapping to identify SLN in cervical cancer (CaCerv) with radioactive colloids, intraoperative detection with patent blue dye (PBD) and gamma probe (GP) and biopsy and comparison of two protocols.
MATERIAL AND METHODS: In 54 patients with CaCerv before hysterectomy and lymph nodes dissection (LND) we performed preoperative lymphoscintigraphy utilizing 99mTc-colloid (Nanocoll, SentiScint or Nanocis), activity 40 MBq, on the operation day (30 women) or the day before operation (24 women). Gynaecologists injected 4 peritumoural injections of colloid into the cervix around the tumour. Scintigraphy followed 25-50 minutes (one-day protocol) or 12-19 hours (two-day protocol) after injection. Gynaecologists also injected 4 peritumoural injections of PBD into the cervix around the tumour. All women underwent SLN biopsy and LND (in average 35 lymph nodes were taken) and hysterectomy. SLNs (active and/or blue lymph nodes) were examined by a pathologist [histopathology and immunohistochemistry (IH) with detection of cytokeratine]. No SLN was examined without IH.
RESULTS: The gynaecologists withdrew 123 SLNs (on average 2.27/1 patient) and in total 1898 lymph nodes (on average 35/1 patient). In 1 woman the tumour was inoperable. Two-day protocol, which involved scintigraphy, PBD and GP detected SLNs on both sides (45 SLNs) in 17 women (70.8%), SLNs on the one side (6 SLNs) in 3 patients (12.5%) and no SLNs were found in 4 women (16.7%). One-day protocol detected SLNs on both sides in 23 patients (74.1%) - 63 SLNs, in 7 women on one side (25.9%) - 9 SLNs. Metastases in SLNs (with or without metastases in other LN) were found in 21 patients (38.9%) - in 1 woman of stage FIGO IB1, in 1 woman of stage FIGO IB2, in 1 patient of stage FIGO IIIA and in all 18 patients of stage FIGO IIIB. False negative SLN detection was 0%.
CONCLUSIONS: In SLN detection in patients with CaCerv, all 3 methods - scintigraphy, PBD and GP - should be used, and the success rate of SLN detection increases, although scintigraphy has lower significance than in SLN detection in malignant melanoma and breast cancer. One-day protocol had a better detection rate of SLN than two-day protocol. The method is promising but its results are not as unequivocal and optimistic as in breast cancer and malignant melanoma, and it is still experimental. Additional experience is necessary.
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Keywords

cervical cancer; sentinel lymph node; lymphoscintigraphy; patent blue dye; surgical gamma probe

About this article
Title

Detection of sentinel lymph nodes in cervical cancer. A comparison of two protocols

Journal

Nuclear Medicine Review

Issue

Vol 9, No 1 (2006)

Pages

65-68

Published online

2006-01-25

Bibliographic record

Nucl. Med. Rev 2006;9(1):65-68.

Keywords

cervical cancer
sentinel lymph node
lymphoscintigraphy
patent blue dye
surgical gamma probe

Authors

Otakar Kraft
Libor Ševcík
Jaroslav Klát
Peter Koliba
Romuald Curík
Hana Kríožvá

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