Contribution of sentinel lymph-node biopsy to treatment of locally advanced stages of cervical cancers

Authors: J. Sláma;  M. Zikán ;  D. Fischerová;  R. Kocián;  A. Germanová;  F. Frühauf;  D. Cibula
Authors‘ workplace: Gynekologicko-porodniká klinika VFN a 1. LF UK, Praha, přednosta prof. MUDr. A. Martan, DrSc.
Published in: Ceska Gynekol 2016; 81(3): 165-170


Usage of sentinel lymph-node (SLN) concept in locally advanced cervical cancers might help to individualise management. According to SLN status could be patients refered to neoadjuvant chemotherapy (NAC) with subsequent surgery or to primary chemoradiation. The aim of our study was to evaluate sensitivity of SLN detection in locally advanced cervical cancers and to assess the impact of NAC on frequency of their metastatic involvement.

Retrospective clinical study.

Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Medical Faculty, Charles University, Prague.

Materials and methods:
Included were patients with cervical cancer stages FIGO IB1 (> 3 cm), IB2, IIA2 and selected cases of stages IIB with incipient parametrial involvement. Patients were distributed into two different protocols – patients in group NAC-SLN were refered to radical hysterectomy with SLN biopsy after 3 cycles of NAC, other patients (group SLN) underwent SLN biopsy and NAC was administered only in SLN-negative cases.

Altogether 101 patients were included (group SLN = 62, group NAC-SLN = 39). Detection of SLN in whole cohort reached 90.1% per patient and 68.3% bilaterally. No differences were found between SLN group and NAC-SLN group in frequency of per patient SLN detection (90.3% vs 89.7%) and bilateral detection (69.4% vs 66.7%). Prevalence of macrometastases, micrometastases and ITC in the SLN group was 37.1% (23/62), 11.3% (7/62) and 8.1% (5/62), respectively. In the NAC-SLN group macrometastases in SLN were detected in 17.9% (7/39) patients, in 1 patient was detected micrometastis in SLN and no patient had ITC. Difference in frequency of metastases in SLN was significant (p = 0,013). No patient had progressed during NAC, complete response was seen in 15.1% (11/73) patients and reduction of tumour volume > 30% in 84.9% (62/73) patients.

Detection of SLN in locally advanced cervical cancers reached comparable results to early stages. NAC did not influence frequency of SLN detection, but it significantly decreased prevalence of metastatic SLN involvement.

cervical cancer, neoadjuvant chemotherapy, sentinel lymph-node


1. Barranger, E., Cortez, A., Grahek, D., et al. Laparoscopic sentinel node procedure for cervical cancer: Impact of neodjuvant chemoradiotherapy. Ann Surg Oncol, 2004, 11, p. 445–452.

2. Cibula, D., Abu-Rustum, NR., Dušek, L., et al. Prognostic signifikance of low volume sentinel lymph node disease in early – stage cervical cancer. Gynecol Oncol, 2012, 124, p. 496–501.

3. Cibula, D., Kužel, D., Sláma, J., et al. Sentinel node (SLN) biopsy in the management of locally advanced cervical cancer. Gynecol Oncol, 2009, 115, p. 46–50.

4. Colombo, N., Peiretti, M. Critical review of neoadjuvant chemotherapy followed by surgery for locally advanced cervical cancer. Int J Gynecol Cancer, 2010, 20, p. S47–S48.

5. Euscher, ED., Malpica, A., Atkinson, EN., et al. Ultrastaging improves detection of metastases in sentinel lymph nodes of uterine cervix squamous cell carcinoma. Am J Surg Pathol, 2008, 32, p. 1336–1343.

6. Fischerova, D., Cibula, D., Stenhova, H., et al. Transrectal ultrasound and magnetic resonance imaging in staging of early cervical cancer. Int J Gynecol Cancer, 2007, 18, p. 766–772.

7. Gortzak-Uzan, L., Jimenez, W., Nofech-Mozes, S., et al. Sentinel node biopsy vs. pelvic lymphadenectomy in early stage cervical cancer: Is it time to change the gold standard? Gynecol Oncol, 2010, 116, p. 28–32.

8. Levenback, CF., van der Zee, AGJ., Rob, L., et al. Sentinel lymph node biopsy in patients with gynecologic cancers. Expert panel statement from the International Sentinel Node Meeting, February 21, 2008. Gynecol Oncol, 2009, 114, p. 151–156.

9. Lopez-Graniel, C., Reyes, M., Chanona, G., et al. Type III radical hysterectomy after induction chemotherapy for patients with locally advanced cervical carcinoma. Int J Gynecol Cancer, 2001, 11, p. 210–217.

10. Modarress, M., Maghami, FQ., Golnavaz, M., et al. Comparative study of chemoradiation and neoadjuvant chemotherapy effects before radical hysterectomy in stage IB–IIB bulky cervical cancer and with tumor diameter greater than 4 cm. Int J Gynecol Cancer, 2005, 15, p. 483–488.

11. 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, p. 281–288.

12. Robova, H., Halaska, M., Pluta, M., et al. The role of neoadjuvant chemotherapy and surgery in cervical cancer. Int J Gynecol Cancer, 2010, 20, p. S42–S46.

13. Robova, H., Rob, L., Halaska, M. J., et al. High-dose neoadjuvant chemotherapy in bulky IB cervical cancer. Gynecol Oncol, 2013, 128, p. 49–53.

14. Sakuragi, N., Satoh, C., Takeda, N., et al. Incidence and distribution pattern of pelvic and paraaortic lymph node metastasis in patiens with stages IB, IIA, and IIB cervical carcinoma treated with radical hysterectomy. Cancer, 1999, 85, p. 1547–1554.

15. Serur, E., Mathews, RP., Gates, J., et al. Neoadjuvant chemotherapy in stage IB2 squamous cell carcinoma of the cervix. Gynecol Oncol, 1997, 65, p. 348–356.

16. Sláma, J., Dundr, P., Dušek, L., et al. Sentinel lymph node status in patients with locally advanced cervical cancers and impact of neoadjuvant chemotherapy. Gynecol Oncol, 2012, 125, p. 303–306.

17. Wydra, D., Sawicki, S., Wojtylak, S., et al. Sentinel node identification in cervical cancer patients undergoing transperitoneal radical hysterectomy: a study of 100 cases. Int J Gynecol Cancer, 2006, 16, p. 649–654.

18. Zanetta, G., Colombo, A., Milani, R., et al. Long-term result of sequential postoperative treatment with vincristine, bleomycin, mitomycin-c, cisplatin and radiotherapy after surgery for high-risk patients with cervical carcinoma stage Ib–IIa. Int J Gynecol Cancer, 1995, 5, p. 40–44.

Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

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