LYMPH NODE MAPPING AND SENTINEL NODE DETECTION IN PATIENTS WITH EARLY CERVICAL CANCER (FIGO IA2-IIA1)

Objectives To report our preliminary results in lymphatic mapping and value of sentinel lymph nodes (SLNs) in prediction of the pelvic lymph node status in cervical cancer. Methods For the detection of SLNs methylene blue is injected intracervicaly in the operating room prior to surgery, at 4 quadrants of the exocervix and at 4 quadrants on the level of transition of the cervix to vaginal fornices. After identification and excision of SLNs, systematic bilateral pelvic lymphadenectomy and radical hysterectomy is performed. Results From December 2011 to April 2013, 22 patients (median age 45) diagnosed with FIGO stage IA2–IIA1 cervical cancer were enrolled in the study (IA2=5, IB1=15, IB2=1, IIA1=1). Sixty eight percent of the patients had squamous cell carcinoma, 23% adenocarcinoma and 9% adenosquamous carcinoma. Intraoperative detection rate was 100%, and SLNs were detected bilaterally in all patients. Total number of 100 SLNs (2.27 per pelvic side), and 521 of non- SLNs (23.7 per patient) were excised. The SLNs were located at the level of common iliac vessels (18%), external iliac vessels (64%), and obturator fossa (36%). Metastatic sentinel nodes were found in 2 patients (9%). We found no positive non-SLNs in the presence of negative SLNs. Conclusions Sentinel node detection is a feasible procedure in cervical cancer patients and increases detection rate of lymph node metastases, thus improving nodal staging. Our preliminary results confirm high detection rate of SLNs using blue dye only. This method is less time consuming then radioisotopes detection method and it is easy to perform.