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The Sentinel Node Technique Detects Unexpected Drainage Pathways and Allows Nodal Ultrastaging in Early Cervical Cancer: Insights from the Multicenter Prospective SENTICOL Study

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Sentinel lymph node (SLN) biopsy may improve nodal staging in cervical cancer. The aims of this study are to determine the rate of unusual patterns of cervical lymphatic drainage, to determine the rates of micrometastases and isolated tumor cells (ITCs) in SLNs, and to assess the clinical impact of SLN biopsy.

Methods

Multicenter prospective study conducted between January 2005 and June 2007 in women undergoing laparoscopic surgery for early cervical cancer. Combined technetium/Patent Blue labeling was used. Lymphoscintigraphy was performed before surgery. SLN location was recorded, and factors associated with location were explored. SLNs underwent step sectioning ± immunohistochemistry.

Results

145 patients were enrolled and 139 included in a modified intention-to-diagnose analysis. Although 80.6 % of SLNs were in external iliac and interiliac areas, 38.2 % of patients had at least one SLN in an unexpected area and 5.1 % had SLNs only in unexpected areas. In unexpected areas, the number of SLNs per patient was not significantly different between lymphoscintigraphy and intraoperative detection (0.79 [0.62–1.02] versus 0.50 [0.37–0.68]; P = 0.096). In expected locations, there were significantly more blue and hot SLNs per patient than blue or hot SLNs (1.70 [1.45–1.99], 0.42 [0.30–0.57], 0.52 [0.39–0.69]). Of 28 metastatic SLNs, 17 contained micrometastases or ITCs. SLN involvement was found only by immunohistochemistry in 39.1 % of patients with positive nodes, and involved SLNs were located in unexpected areas in 17 % of those patients.

Conclusions

Sentinel lymph node biopsy detects unusual drainage pathways and micrometastases in a substantial proportion of patients, thus improving nodal staging.

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Acknowledgment

This work was supported by clinical research grant no. AOR 03063 to the National Hospital Clinical Research Project, 2003; by the French National Cancer Institute (INCA), Boulogne Billancourt, France; and by the Programme Hospitalier de Recherche Clinique (PHRC) and Soutien aux Technologies et Innovations Coûteuses (STIC). We are grateful to Gilles Chatellier (clinical trial administrator), Emilie Lenain (statistician), Noël Lucas (clinical trial administrator), Dominique Mariolle (financial account manager), Isabelle Sauret (clinical trial coordinator), Jean-François Leforestier (data manager), and Sonia Branco (clinical research associate) from the Unité de Recherche Clinique of the Hôpital Européen Georges-Pompidou, a publicly funded teaching hospital in Paris, France (Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Unité d’Epidémiologie et de Recherche Clinique, Paris, France). We thank the following: Hôpital Edouard Herriot-Hospices Civils de Lyon, Lyon (Laurent Magaud, clinical trial coordinator); Center Oscar Lambret, Lille [Pathology (Isabelle Farre) and Nuclear Medicine (Hélène Gauthier)]; Institut Gustave Roussy, Villejuif [Pathology (Pierre Duvillard) and Nuclear Medicine (Sophie Leboulleux)]; Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris [Pathology (Annie Cortez) and Nuclear Medicine (Khaldoun Kerrou)]; and Hôpital Bretonneau, CHRU de Tours, Tours [Pathology (Flavie Arbion) and Nuclear Medicine].

Conflicts of interest

No conflict of interest is reported for any of the authors.

Author information

Authors and Affiliations

  1. Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France

    Anne-Sophie Bats MD, PhD, Florence Gillaizeau MSc, PhD & Fabrice Lécuru MD, PhD

  2. Chirurgie Cancérologique Gynécologique et du Sein, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France

    Anne-Sophie Bats MD, PhD & Fabrice Lécuru MD, PhD

  3. INSERM UMR-S 747, Université Paris Descartes, Sorbonne Paris Cité, Paris, France

    Anne-Sophie Bats MD, PhD & Fabrice Lécuru MD, PhD

  4. Hôpital Femme-Mère-Enfant, Bron, France

    Patrice Mathevet MD, PhD

  5. Université Lyon I, Lyon, France

    Patrice Mathevet MD, PhD

  6. Département de Pathologie Est, Groupement Hospitalier Est, Bron, France

    Annie Buenerd MD

  7. Médecine Nucléaire, Hôpital Edouard Herriot, Lyon, France

    Isabelle Orliaguet MD

  8. Anatomo-pathologie, Institut Claudius Regaud, Toulouse, France

    Eliane Mery MD

  9. Médecine Nucléaire, Institut Claudius Regaud, Toulouse, France

    Slimane Zerdoud MD

  10. Anatomo-pathologie, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France

    Marie-Aude Le Frère-Belda MD, PhD

  11. Service de Médecine Nucléaire, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France

    Marc Froissart MD, PhD

  12. Chirurgie Générale, Institut Claudius Regaud, Toulouse, France

    Denis Querleu MD & Alejandra Martinez MD

  13. Centre Oscar Lambret, Lille, France

    Eric Leblanc MD

  14. Institut Gustave Roussy, Villejuif, France

    Philippe Morice MD, PhD

  15. Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France

    Emile Daraï MD, PhD

  16. CHRU de Tours, Hôpital Bretonneau, Tours, France

    Henri Marret MD, PhD

  17. Département d’Informatique Hospitalière, Evaluation et Gestion des Connaissances, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France

    Florence Gillaizeau MSc, PhD

  18. INSERM, Centre d’Investigation Epidémiologique 4, Paris, France

    Florence Gillaizeau MSc, PhD

Authors
  1. Anne-Sophie Bats MD, PhD
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  2. Patrice Mathevet MD, PhD
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  3. Annie Buenerd MD
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  4. Isabelle Orliaguet MD
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  5. Eliane Mery MD
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  6. Slimane Zerdoud MD
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  7. Marie-Aude Le Frère-Belda MD, PhD
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  9. Denis Querleu MD
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  10. Alejandra Martinez MD
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  11. Eric Leblanc MD
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  12. Philippe Morice MD, PhD
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  13. Emile Daraï MD, PhD
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  14. Henri Marret MD, PhD
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  15. Florence Gillaizeau MSc, PhD
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  16. Fabrice Lécuru MD, PhD
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Corresponding authors

Correspondence to Anne-Sophie Bats MD, PhD or Fabrice Lécuru MD, PhD.

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Bats, AS., Mathevet, P., Buenerd, A. et al. The Sentinel Node Technique Detects Unexpected Drainage Pathways and Allows Nodal Ultrastaging in Early Cervical Cancer: Insights from the Multicenter Prospective SENTICOL Study. Ann Surg Oncol 20, 413–422 (2013). https://doi.org/10.1245/s10434-012-2597-7

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  • DOI: https://doi.org/10.1245/s10434-012-2597-7

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