Histopathologic Validation of the Sentinel Node Technique for Early-Stage Cervical Cancer Patients
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ORIGINAL ARTICLE – GYNECOLOGIC ONCOLOGY
Histopathologic Validation of the Sentinel Node Technique for Early-Stage Cervical Cancer Patients Patrice Mathevet, MD, PhD1,2, Benedetta Guani, MD1,2 , Andrea Ciobanu, MD3, Eliane Mery Lamarche, MD4, Florent Boutitie, MD5, Vincent Balaya, MD1,2, and Fabrice Lecuru, MD, PhD6,7 1
Department of Gynecology, University Hospital of Lausanne, Lausanne, Switzerland; 2Department of Medicine, University of Lausanne, Lausanne, Switzerland; 3Department of Gynecology, Leman Hospital, Thonon Les Bains, France; 4 Department of Pathology, IUCT Oncopole, Toulouse, France; 5Department of Biostatistics, University Hospital of Lyon, Lyon, France; 6Paris Descartes University, Paris, France; 7Department of Gynecology, Curie Institute, Paris, France
ABSTRACT Background. The sentinel lymph node (SLN) biopsy may be an alternative to systematic lymphadenectomy in early cervical cancer. The SLN biopsy is less morbid and has been shown to have high sensitivity for metastasis detection. However, the sensitivity of the SLN technique might be overevaluated because SLNs are examined with ultrastaging, and non-sentinel nodes usually are examined only with routine techniques. This study aimed to validate the negative predictive value (NPV) of the SLN technique by the ultra-staging of SLNs and non-sentinel nodes (NSLNs). Methods. The SENTICOL 1 study data published in 2011 were used. All nodes (i.e., SLNs and NSLNs) were secondarily subjected to ultra-staging. The ultra-staging consisted of sectioning every 200 lm, in addition to immunohistochemistry. Moreover, the positive slides and 10% of the negative slides were reviewed. Results. The study enrolled 139 patients, and SLNs were detected in 136 (97.8%) of these patiets. Bilateral SLNs were detected in 104 (76.5%) of the 136 patients. A total of 2056 NSLNs were identified (median, 13 NSLNs per patient; range 1–54). Of the 136 patients with SLNs, 23 were shown
Abstract presented at the ASCO Meeting 2020, Chicago on 29 May 2020. Ó The Author(s) 2020 First Received: 20 July 2020 Accepted: 19 October 2020 B. Guani, MD e-mail: [email protected]
to have positive SLNs after serial sectioning and immunohistochemical staining. The NSLNs were metastatic in six patients. In the case of bilateral SLN detection, the NPV was 100%, with no false-negatives (FNs). Conclusions. The pelvic SLN technique is safe and trustworthy for determining the nodal status of patients with early-stage cervical cancer. In the case of optimal mapping with bilateral detection, the NPV was found to be 100%.
In early-stage cervical cancer, lymph node status is one of the most important prognostic factors. The revised International Federation of Gynecology and Obstetrics (FIGO) 2018 classification,1 which specifically defines lymph node involvement as stage 3C disease, highlights the importance of lymph node metastasis as a major prognostic factor in cervical cancer. In contrast to macrometastases (MACs) and micrometastases (MICs), the presence of isolated tumor cells (ITCs) does not
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