Sentinel lymph node (SLN) mapping can be an accurate staging procedure for patients with early-stage cervical cancer, regardless of metastatic risk, according to research published in Gynecologic Oncology.

The SENTIREC CERVIX study (ClinicalTrials.gov Identifiers: NCT02825355 and NCT02820506) enrolled 245 adults with early-stage cervical cancer.

The patients were divided into 2 groups: those with a lower risk of metastatic disease (FIGO IA2-IB1 with tumor size ≤20 mm) and those with a higher risk of metastatic disease (FIGO IB1 with tumor size >20 mm, IB2, and IIA1).

Continue Reading

Patients with lower-risk disease (n=130) underwent SLN mapping alone. The higher-risk group (n=115) underwent SLN mapping as well as pelvic lymphadenectomy and removal of FDG-PET/CT-positive nodes. All procedures were minimally invasive, robotic-assisted laparoscopic surgeries.

The SLN mapping algorithm involved first excising all mapped sentinel nodes for ultrastaging, then removing any suspicious-appearing nodes or PET-positive nodes. If mapping was not successful on half of the pelvis, pelvic lymphadenectomy was performed on the affected side. Para-aortic lymph node dissection could be performed at the surgeon’s discretion.

The SLN detection rate was 96.3% overall (82.0% bilateral detection), 94.8% in higher-risk patients (80.9% bilateral detection), and 97.7% in lower-risk patients (83.1% bilateral detection).

Among higher-risk patients, SLN mapping had a sensitivity of 96.3% and a negative predictive value of 98.7%. These results suggest that SLN mapping alone could replace pelvic lymphadenectomy in higher-risk patients, according to the study authors.

However, the authors recommended continuing to use pelvic lymphadenectomy in higher-risk patients until more safety data are available.

Reference

Sponholtz SE, Mogensen O, Hildebrandt MG, et al. Sentinel lymph node mapping in early-stage cervical cancer – A national prospective multicenter study (SENTIREC trial). Gynecol Oncol. Published online July 2, 2021. doi:10.1016/j.ygyno.2021.06.018

Topics:

Cervical Cancer Gynecologic Cancers