SLN mapping in early-stage cervical cancer as a minimal-invasive triaging tool for multimodal treatment

Andrea Papadia; Chiara Morosi; Junjie Wang; Maria Luisa Gasparri; Tilman Rau; Fabio Ghezzi; Michael D Mueller

doi:10.1016/j.ejso.2019.01.184

SLN mapping in early-stage cervical cancer as a minimal-invasive triaging tool for multimodal treatment

Eur J Surg Oncol. 2019 Apr;45(4):679-683. doi: 10.1016/j.ejso.2019.01.184. Epub 2019 Jan 30.

Authors

Andrea Papadia¹, Chiara Morosi², Junjie Wang³, Maria Luisa Gasparri⁴, Tilman Rau⁵, Fabio Ghezzi⁶, Michael D Mueller⁷

Affiliations

¹ Department of Obstetrics and Gynecology, University Hospital of Bern and University of Berne, Berne, Switzerland. Electronic address: andrea.papadia@insel.ch.
² Department of Obstetrics and Gynecology, University Hospital of Bern and University of Berne, Berne, Switzerland; Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
³ Department of Gynaecological Oncology, KK Women's & Children's Hospital, Singapore.
⁴ Department of Obstetrics and Gynecology, University Hospital of Bern and University of Berne, Berne, Switzerland; Department of Gynecology and Obstetrics, "Sapienza" University of Rome, Rome, Italy.
⁵ Institute of Pathology, University of Bern, Murtenstrasse 31, Room L310, 3008, Bern, Switzerland.
⁶ Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
⁷ Department of Obstetrics and Gynecology, University Hospital of Bern and University of Berne, Berne, Switzerland.

PMID: 30732972
DOI: 10.1016/j.ejso.2019.01.184

Abstract

Background: To evaluate sensitivity, false negative rate and negative predictive value of the combination of sentinel lymph node (SLN) mapping and frozen section (FS) in triaging cervical cancer patients to a definitive chemo-radiotherapy.

Methods: A retrospective analysis of patients with histologically proven cervical cancer undergoing laparoscopic SLN mapping and frozen section of the SLNs followed by a completion radical hysterectomy, pelvic and/or paraarotic lymphadenectomy. Sensitivity, false negative rate and negative predictive value of the SLN mapping, of the frozen section and of the combination of the two in identifying micro- and macrometastases were calculated.

Results: One-hundred and four patients with cervical cancer underwent surgery. Of these, 87 (83.7%) had bilateral detection rates at the SLN mapping and underwent FS evaluation and were selected for statistical analysis. Twenty-five patients had lymph nodal metastases at H&E staining. Of these, 24 displayed metastatic disease to the SLNs and one to a NSLN accounting for a FN rate of 4.0%. Metastases were identified in 21 patients at the FS analysis. Four patients had metastases in the SLNs that were missed at the FS analysis. The FN rate of the FS is 12.5% if we excluded isolated tumour cells in the analysis. The FN rate of the combined methodology (SLN mapping and FS of the SLN) is 16%. Twenty-one out of 25 patients (84.0%) could correctly be triaged to a definitive chemo-radiotherapy.

Conclusions: The combination of SLN mapping and FS of the SLNs is efficient in triaging patients to a definitive chemo-radiotherapy.

Keywords: Cervical cancer; Chemo-radiotherapy; Frozen section analysis; Indocyanine green; Laparoscopy; Sentinel lymph node mapping.

MeSH terms

Adenocarcinoma / secondary*
Adenocarcinoma / therapy
Adult
Aged
Carcinoma, Squamous Cell / secondary*
Carcinoma, Squamous Cell / therapy
Chemoradiotherapy*
False Negative Reactions
Female
Frozen Sections
Humans
Hysterectomy
Laparoscopy
Lymph Node Excision
Middle Aged
Neoplasm Micrometastasis / pathology*
Neoplasm Staging
Patient Selection
Predictive Value of Tests
Retrospective Studies
Sentinel Lymph Node / pathology*
Sentinel Lymph Node / surgery
Triage
Uterine Cervical Neoplasms / pathology*
Uterine Cervical Neoplasms / therapy