Lymphatic Mapping and Sentinel Node Lymphoscyntygraphy in Patients With Early Advanced Cervical Cancer

Many centres persist advocating complete pelvic and in some cases paraaortic lymphadenectomy in early cervical cancer. There is not sufficient evidence that survival advantages related to more complete versus less complete dissections of node exist. Beside this a complete dissection of lymph node it is impossible. Lymph nodes have a significant role in immune surveillance on the one hand and the status of lymph nodes is a independent prognostic factor for most solid tumours on the other hand. The concept of lymph node mapping and sentinel node (SLN) is among other things an attempt at coming to terms with the two contradiction. Lymphoscyntygra- phy enables the visualisation of lymphatic drainage patterns and according to sentinel node concept, after administration, the radiolabeled tracer will first be retained by the sentinel node. The current procedure is to perform the preoperative mapping of sentinel node(s) by static and/or dynamic lymphoscyntygraphy, followed by in vivo identification using a gamma detection probe and selective surgical resection. Thirty patients with cervical cancer stager IA2- IIA treated with primarily radical hysterectomy type II or III were subjected to the study.The day before surgery 99 mTc radiolabed nannocolloid (100 MBq 2 ml in volume) was applied in each quadrant of the cervix. The static scyntygraphy scans were performed after 2 h p.i. using dual-head large field of view Siemens gamma camera equipped in high resolution collmators. SLNs were identified intraopertively using a handheld gamma-detection probe (Navigator GPS) and intraopertive lymphatic mapping with blue dye(Patent Blau). In all patients SLN procedure revealed accumulation of the tracer above background which was classified as sentinel nodes. Five patients (16,66) had lymph node metastases. Sensitivity of sentinel node as far as metastases are concerned was 0.8, and negative predictive value 0.96. There wee no false negative results. There were no severe adverse effects of tracer of blue dye application. Preoperative lymphoscyntygraphy and intraoperative lymphatic mapping are highly successful at identifying sentinel nodes in patients undergoing radical hysterectomy due to early advanced cervical cancer.