Sentinel lymph node detection in patients with cervical cancer

Purpose. We investigated the validity of sentinel lymph node (SLN) detection after radioactive isotope and/or blue dye injection in patients with cervical cancer. Patients and methods. Between December 1998 and May 2000, 50 patients (mean age 44 years) with cervical cancer FIGO stage I (n = 32), stage II (n = 16), or stage IV (n = 2) underwent SLN detection during primary operation (radical laparoscopic-vaginal or abdominal hysterectomy, exenteration). The day before surgery 1 ml of Albu-Res labeled with 50 MBq Technetium 99m was applied into the cervix at 3(00), 6(00), 9(00), and 12(00). Blue dye injection (Patentblue) occurred intraoperatively into the cervix at the same locations. Results. The detection rate of SLN was 78%. Ten patients (20.0%) were diagnosed with lymph node metastases. No SLN was detected in 10 patients, of which 4 patients had positive lymph nodes. Sensitivity and negative predictive value were 83.3 and 97.1%, respectively. The false-negative rate was 16.6% (1 of 6 patients). After the combined injection, the detection rate, sensitivity, and negative predictive values were 100%. A mean of 2.7 pelvic and 2.6 para-aortic SLNs were detected. Para-aortic SLNs were located in the paracaval region in 66.6%, whereas pelvic SLNs were detected in 25.7% at the origin of the uterine artery and in 24.7% at the division of the common iliac artery. Conclusion. A combination of radioactively labeled albumin with blue dye allows successful detection of SLN in patients with cervical cancer. The clinical validity of this technique must be evaluated prospectively. (C) 2001 Academic Press.