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Sentinel node detection with 99mTc phytate alone is satisfactory for cervical cancer patients undergoing radical hysterectomy and pelvic lymphadenectomy

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International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

If the sentinel-lymph-node (SLN) concept is valid in cervical cancer, most patients could avoid pelvic lymphadenectomy when absence of metastasis is intraoperatively confirmed in the SLN. We assessed feasibility and accuracy of SLN detection using 99mTc phytate in patients with cervical cancer.

Methods

Eighty-two women with stage Ia–IIb cervical cancer enrolled in this study. All underwent hysterectomy or trachelectomy with accompanying total pelvic lymphadenectomy. On the day before surgery, we injected fluid containing 99mTc-labeled phytate subepithelially into four cervical quadrants outside the tumor. Intraoperatively, SLNs were identified as radioactive “hot nodes” by gamma probe. Systematic bilateral pelvic lymphadenectomy was performed after the hot node sampling to evaluate the predictive ability of hot nodes.

Results

A total of 157 lymph nodes were detected as SLNs in 72 of 82 patients. SLN detection rate was 88%. Detection rate was 95% for the subgroups of patients with stage Ia–Ib1 disease and smaller tumor size (≤3 cm in maximal diameter). Lymph node metastasis was found in 15 patients. In 3 of them, no SLNs were detected. In the remaining 12 patients, each ipsilateral SLN contained metastasis when the pelvic lymph nodes contained metastases. Sensitivity was 100%, the false negative rate was 0%, and the negative predictive value of SLN was 100%.

Conclusion

We conclude SLN detection using 99mTc-labeled phytate is satisfactory to assess pelvic nodes in patients with early cervical cancer; if validated with other research, it should be incorporated into clinical practice.

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Acknowledgments

We thank the members of our department of obstetrics and gynecology: Drs. Yousuke Ueoka, Kaoru Okugawa, Shuichi Taniguchi, Takafumi Inoue, Eisuke Kaneki, and M.T. Emiko Hori. This work was supported by Grants-in-Aid (Nos. 20591953 and 19591936) for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan.

Conflict of interest statement

No author has any conflict of interest.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Shinji Ogawa, Hiroaki Kobayashi, Hideaki Yahata, Kenzo Sonoda & Norio Wake

  2. Department of Obstetrics and Gynecology, Kitakyushu Municipal Medical Center, Kitakyushu, Japan

    Satoshi Amada

  3. Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Koichiro Abe & Shingo Baba

  4. Division of Medical Quantum Science, Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Masayuki Sasaki

  5. Division of Maternal Health, Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Tsunehisa Kaku

Authors
  1. Shinji Ogawa
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  2. Hiroaki Kobayashi
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  3. Satoshi Amada
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  4. Hideaki Yahata
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  5. Kenzo Sonoda
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  6. Koichiro Abe
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  7. Shingo Baba
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  8. Masayuki Sasaki
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  9. Tsunehisa Kaku
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  10. Norio Wake
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Corresponding author

Correspondence to Hiroaki Kobayashi.

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Ogawa, S., Kobayashi, H., Amada, S. et al. Sentinel node detection with 99mTc phytate alone is satisfactory for cervical cancer patients undergoing radical hysterectomy and pelvic lymphadenectomy. Int J Clin Oncol 15, 52–58 (2010). https://doi.org/10.1007/s10147-009-0010-8

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  • DOI: https://doi.org/10.1007/s10147-009-0010-8

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