Skip to main content
SpringerLink
Log in

Accuracy of Sentinel Lymph Node Mapping After Previous Hysterectomy in Patients with Occult Cervical Cancer

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

Abstract

Background

In patients with a diagnosis of occult cervical cancer made on a hysterectomy specimen after surgery for a benign indication, lymph node assessment is crucial to determine treatment. We aimed to compare sentinel lymph node (SLN) mapping between patients with postoperative diagnosis of occult cervical carcinoma and patients with cervical cancer and uterus in situ.

Methods

A retrospective analysis of cervical cancer patients International Federation of Gynecology and Obstetrics (FIGO) stage IA–IIA disease undergoing laparoscopic SLN mapping was performed. Patients were divided into two groups: those with a diagnosis of occult cervical cancer made on a hysterectomy specimen (group 1) and those with a diagnosis of cervical cancer and uterus in situ (group 2). Tracers used for SLN mapping included technetium-99m (99mTc), blue dye, and indocyanine green. After detection and excision, the SLN was sent for frozen section analysis, and the planned surgical procedure was aborted in case of metastatic disease in favor of a chemoradiotherapeutic treatment.

Results

Groups 1 and 2 included 9 and 62 patients, respectively. Clinicopathologic characteristics were similar among the two groups. Overall and bilateral detection rates were 66.6 and 33.3 and 95.1 and 87 % in groups 1 and 2, respectively (p < 0.05). No false-negative SLNs were identified in either group, with a negative predictive value of 100 %.

Conclusions

SLN mapping in occult cervical cancer patients has lower detection rates compared to patients with uterus in situ. In these patients, proper management of their disease has already failed before diagnosis, and additional mistakes may definitely compromise attempts at cure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Narducci F, Merlot B, Bresson L, et al. Occult invasive cervical cancer found after inadvertent simple hysterectomy: is the ideal management: systematic parametrectomy with or without radiotherapy or radiotherapy only? Ann Surg Oncol. 2015;22:1349–52.

    Article  PubMed  Google Scholar 

  2. Jiang H, Qu L, Liu X et al. A comparison of laparoscopic and abdominal radical parametrectomy for cervical cancer or vaginal apex carcinoma and stage II endometrial cancer after hysterectomy. JSLS. 2013;17:249–62.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Covens A, Rosen B, Murphy J, et al. How important is removal of the parametrium at surgery for carcinoma of the cervix? Gynecol Oncol. 2002;84:145–9.

    Article  CAS  PubMed  Google Scholar 

  4. Pluta M, Rob L, Charvat M, et al. Less radical surgery than radical hysterectomy in early stage cervical cancer: a pilot study. Gynecol Oncol. 2009;113:181–4.

    Article  PubMed  Google Scholar 

  5. Frumovitz M, Sun CC, Schmeler KM, et al. Parametrial involvement in radical hysterectomy specimens for women with early-stage cervical cancer. Obstet Gynecol. 2009;114:93–9.

    Article  PubMed  Google Scholar 

  6. Jeon HW, Suh DH, Kim K, No JH, Kim YB. Lymphadenectomy alone is a feasible option in managing incidentally-detected early stage cervical cancer after simple hysterectomy without intermediate-risk factors: an application of the concept of less radical surgery. Anticancer Res. 2013;33:5135–41.

    PubMed  Google Scholar 

  7. Gemer O, Eitan R, Gdalevich M, et al. Can parametrectomy be avoided in cervical cancer? An algorithm for the identification of patients at low risk of patients for parametrial involvement. Eur J Surg Oncol. 2013;39:76–80.

    Article  CAS  PubMed  Google Scholar 

  8. Schmeler KM, Frumovitz M, Ramirez PT. Conservative management of early stage cervical cancer: is there a role for less radical surgery? Gynecol Oncol. 2011;120:321–5.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sedlis A, Bundy BN, Rotman MZ, Lentz SS, Muderspach LI, Zaino RJ. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: a Gynecologic Oncology Group study. Gynecol Oncol. 1999;73:177–83.

    Article  CAS  PubMed  Google Scholar 

  10. Rotman M, Sedlis A, Piedmonte MR, et al. A phase III randomized trial of postoperative pelvic irradiation in stage IB cervical carcinoma with poor prognostic features: follow-up of a Gynecologic Oncology Group study. Int J Radiat Oncol Biol Phys. 2006;65:196–76.

    Article  PubMed  Google Scholar 

  11. Peters WA, Liu PY, Barret RJ, et al. Concurrent chmotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol. 2000;18:1606–13.

    CAS  PubMed  Google Scholar 

  12. Papadia A, Remorgida V, Salom EM, Ragni N. Laparoscopic pelvic and paraaortic lymphadenectomy in gynecologic oncology. J Am Assoc Gynecol Laparosc. 2004;11:297–306.

    Article  PubMed  Google Scholar 

  13. Bogani G, Cromi A, Serati M, et al. Improving standard of care through introduction of laparoscopy for the surgical management of gynecological malignancies. Int J Gynecol Cancer. 2015;25:741–50.

    Article  PubMed  Google Scholar 

  14. Lécuru F, Bats AS, Bensaid C, et al. Sentinel lymph node in low stage cervical cancers. Current data. Quality assurance. Prospects. Bull Cancer. 2014;101:349–53.

    PubMed  Google Scholar 

  15. Darlin L, Persson J, Bossmar T, et al. The sentinel node concept in early cervical cancer performs well in tumors smaller than 2 cm. Gynecol Oncol. 2010;117:266–9.

    Article  PubMed  Google Scholar 

  16. Rob L, Strnad P, Robova H, et al. Study of lymphatic mapping and sentinel node identification in early stage cervical cancer. Gynecol Oncol. 2005;98:281–8.

    Article  PubMed  Google Scholar 

  17. Rob L, Robova H, Halaska MJ, Hruda M, Skapa P. Current status of sentinel lymph node mapping in the management of cervical cancer. Expert Rev Anticancer Ther. 2013;13:861–70.

    Article  PubMed  Google Scholar 

  18. Alander JT, Kaartinen I, Laakso A, et al. A review of indocyanine green fluorescent imaging in surgery. Int J Biomed Imaging. 2012;2012:940585.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Rossi EC, Ivanova A, Boggess JF. Robotically assisted fluorescence-guided lymph node mapping with ICG for gynecologic malignancies: a feasibility study. Gynecol Oncol. 2012;124:78–82.

    Article  PubMed  Google Scholar 

  20. Schaafsma BE, van der Vorst JR, Gaarenstroom KN, et al. Randomized comparison of near-infrared fluorescence lymphatic tracers for sentinel lymph node mapping of cervical cancer. Gynecol Oncol. 2012;127:126–30.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Jewell EL, Huang JJ, Abu-Rustum NR, et al. Detection of sentinel lymph nodes in minimally invasive surgery using indocyanine green and near-infrared fluorescence imaging for uterine and cervical malignancies. Gynecol Oncol. 2014;133:274–7.

    Article  PubMed  Google Scholar 

  22. Ditto A, Martinelli F, Bogani G, et al. Sentinel node mapping using hysteroscopic injection of indocyanine green and laparoscopic near-infrared fluorescence imaging in endometrial cancer staging. J Minim Invasive Gynecol. 2015;22:132–3.

    Article  PubMed  Google Scholar 

  23. Di Stefano AB, Acquaviva G, Garozzo G, et al. Lymph node mapping and sentinel node detection in patients with cervical carcinoma: a 2-year experience. Gynecol Oncol. 2005;99:671–9.

    Article  PubMed  Google Scholar 

  24. Kato H, Todo Y, Minobe S, et al. Previous conization on patient eligibility of sentinel lymph node detection for early invasive cervical cancer. Int J Gynaecol Cancer. 2011;21:1491–4.

    Article  Google Scholar 

  25. Meigs JV. The radical operation for cancer of the cervix. Am J Roentgenol Radium Ther. 1947;57:679–84.

    CAS  PubMed  Google Scholar 

  26. Park JY, Kim DY, Kim JH et al. (2010) Management of occult invasive cervical cancer found after simple hysterectomy. Ann Oncol. 21:994–1000.

    Article  PubMed  Google Scholar 

  27. Ercoli A, Delmas V, Iannone V, et al. The lymphatic drainage of the uterine cervix in adult fresh cadavers: anatomy and surgical implications. Eur J Surg Oncol. 2010;36:298–303.

    Article  CAS  PubMed  Google Scholar 

  28. Karima AC, Derks M, Smit NN, et al. Lymphatic drainage from the cervix uteri: implications for radical hysterectomy? Gynecol Oncol. 2014;132:107–13.

    Article  Google Scholar 

  29. Woelber L, Grimm D, Vettorazzi E, et al. Secondary sentinel node biopsy after previous excision of the primary tumor in squamous cell carcinoma of the vulva. Ann Surg Oncol. 2013;20:1701–6.

    Article  PubMed  Google Scholar 

  30. McCready DR, Ghazarian DM, Hershkop MS, Walker JA, Ambus U, Quirt IC. Sentinel lymph-node biopsy after previous wide local excision for melanoma. Can J Surg. 2001;44:432–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Gannon CJ, Rousseau DL Jr, Ross MI, et al. Accuracy of lymphatic mapping and sentinel lymph node biopsy after previous wide local excision in patients with primary melanoma. Cancer. 2006;107:2647–52.

    Article  PubMed  Google Scholar 

  32. Ariyan S, Ali-Salaam P, Cheng DW, Truini C. Reliability of lymphatic mapping after wide local excision of cutaneous melanoma. Ann Surg Oncol. 2007;14:2377–83.

    Article  PubMed  Google Scholar 

  33. Imboden S, Papadia A, Nauverk M, et al. A comparison of radiocolloid and indocyanine green fluorescence imaging, sentinel lymph node mapping in patients with cervical cancer undergoing laparoscopic surgery. Ann Surg Oncol. 2015;22:4198–203.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Holman LL, Levenback CF, Frumovitz M. Sentinel lymph node evaluation in women with cervical cancer. J Minim Invasive Gynecol. 2014;21:540–5.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Diaz JP, Gemignani ML, Pandit-Taskar N, et al. Sentinel lymph node biopsy in the management of early-stage cervical carcinoma. Gynecol Oncol. 2011;120:347–52.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, Berne, Switzerland

    Andrea Papadia MD, PhD, Sara Imboden MD, Anja Fink MD, Maria Luisa Gasparri MD, Daniele Bolla MD & Michael D. Mueller MD

  2. Department of Gynecology and Obstetrics, “Sapienza” University of Rome, Rome, Italy

    Maria Luisa Gasparri MD

Authors
  1. Andrea Papadia MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sara Imboden MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anja Fink MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maria Luisa Gasparri MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniele Bolla MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael D. Mueller MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrea Papadia MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Papadia, A., Imboden, S., Fink, A. et al. Accuracy of Sentinel Lymph Node Mapping After Previous Hysterectomy in Patients with Occult Cervical Cancer. Ann Surg Oncol 23, 2199–2205 (2016). https://doi.org/10.1245/s10434-015-5066-2

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-015-5066-2

Keywords

Search

Navigation