Open AccessBeyond sentinel node algorithm. Toward a more tailored surgery for cervical cancer patients
Author(s) -
Fagotti Anna,
Pedone Anchora Luigi,
Conte Carmine,
Chiantera Vito,
Vizza Enrico,
Tortorella Lucia,
Surico Daniela,
De Iaco Pierandrea,
Corrado Giacomo,
Fanfani Francesco,
Gallotta Valerio,
Scambia Giovanni
Publication year - 2016
Publication title -
cancer medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 53
ISSN - 2045-7634
DOI - 10.1002/cam4.722
Subject(s) - medicine , stage (stratigraphy) , adenosquamous carcinoma , cervical cancer , sentinel lymph node , lymphadenectomy , algorithm , radiology , lymph node , sentinel node , magnetic resonance imaging , radical hysterectomy , cancer , biopsy , surgery , adenocarcinoma , breast cancer , paleontology , computer science , biology
Nowadays cervical cancer is frequently diagnosed at early stage. For these patients lymph node metastasis ( LNM ) is considered the most important prognostic factor. During the last decade many efforts have been made to reduce rate of complications associated with lymphadenectomy ( LND ). A great interest has arisen in sentinel lymph node ( SLN ) biopsy as a technique able to decrease number of LND performed and, at the same time, to assess lymph nodal status. High diagnostic performances have been reached thanks to SLN surgical algorithm. However, despite the efforts, about 25% of these patients undergo at least unilateral LND to meet NCCN recommendations. Data of women with International Federation of Gynecology and Obstetrics stage IA 1‐ IB 1/ IIA 1 cervical carcinoma were retrospectively collected by six Italian institutions. All patients underwent complete preoperative staging workup and were primarily treated by radical hysterectomy and pelvic bilateral LND . A total of 368 patients with early‐stage cervical cancer were identified. Among them 333 (90.5%) showed no suspicious enlarged nodes at the preoperative magnetic resonance imaging ( MRI ). In this subset, tumor diameter ≥20 mm was the only independent predictor of LN status ( P = 0.003). None of the 106 patients with negative MRI nodal assessment, with squamous and adenosquamous histotype and a tumor diameter less than 2 cm had LNM . Based on these results we propose a new modified SLN surgical algorithm that could safely reduce LND performed in patients with very low‐risk early‐stage cervical cancer.