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Sznurkowski JJ, Bodnar L, Szylberg Ł, Zołciak-Siwinska A, Dańska-Bidzińska A, Klasa-Mazurkiewicz D, Rychlik A, Kowalik A, Streb J, Bidziński M, Sawicki W. The Polish Society of Gynecological Oncology Guidelines for the Diagnosis and Treatment of Cervical Cancer (v2024.0). J Clin Med 2024; 13:4351. [PMID: 39124620 PMCID: PMC11313441 DOI: 10.3390/jcm13154351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/11/2024] [Accepted: 07/19/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Recent publications underscore the need for updated recommendations addressing less radical surgery for <2 cm tumors, induction chemotherapy, or immunotherapy for locally advanced stages of cervical cancer, as well as for the systemic therapy for recurrent or metastatic cervical cancer. Aim: To summarize the current evidence for the diagnosis, treatment, and follow-up of cervical cancer and provide evidence-based clinical practice recommendations. Methods: Developed according to AGREE II standards, the guidelines classify scientific evidence based on the Agency for Health Technology Assessment and Tariff System criteria. Recommendations are graded by evidence strength and consensus level from the development group. Key Results: (1) Early-Stage Cancer: Stromal invasion and lymphovascular space involvement (LVSI) from pretreatment biopsy identify candidates for surgery, particularly for simple hysterectomy. (2) Surgical Approach: Minimally invasive surgery is not recommended, except for T1A, LVSI-negative tumors, due to a reduction in life expectancy. (3) Locally Advanced Cancer: concurrent chemoradiation (CCRT) followed by brachytherapy (BRT) is the cornerstone treatment. Low-risk patients (fewer than two metastatic nodes or FIGO IB2-II) may consider induction chemotherapy (ICT) followed by CCRT and BRT after 7 days. High-risk patients (two or more metastatic nodes or FIGO IIIA, IIIB, and IVA) benefit from pembrolizumab with CCRT and maintenance therapy. (4) Metastatic, Persistent, and Recurrent Cancer: A PD-L1 status from pretreatment biopsy identifies candidates for Pembrolizumab with available systemic treatment, while triplet therapy (Atezolizumab/Bevacizumab/chemotherapy) becomes a PD-L1-independent option. Conclusions: These evidence-based guidelines aim to improve clinical outcomes through precise treatment strategies based on individual risk factors, predictors, and disease stages.
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Affiliation(s)
- Jacek J. Sznurkowski
- Profesor Sznurkowski Podmiot Leczniczy, ul. Stefana Żeromskiego 23A, 81-246 Gdynia, Poland
| | - Lubomir Bodnar
- Faculty of Medical Sciences and Health Sciences, University of Siedlce, 08-110 Siedlce, Poland;
- Department of Clinical Oncology and Radiotherapy, Siedlce Cancer Center, 08-110 Siedlce, Poland
| | - Łukasz Szylberg
- Department of Tumor Pathology and Pathomorphology, Oncology Centre Prof. Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland;
- Department of Obstetrics, Gynecology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-168 Bydgoszcz, Poland
| | - Agnieszka Zołciak-Siwinska
- Department of Gynecological Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.Z.-S.); (A.R.); (M.B.)
| | - Anna Dańska-Bidzińska
- Department of Gynecologic Oncology, Second Clinic of Obstetrics and Gynecology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Dagmara Klasa-Mazurkiewicz
- Department of Obstetrics and Gynecological Oncology, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Agnieszka Rychlik
- Department of Gynecological Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.Z.-S.); (A.R.); (M.B.)
| | - Artur Kowalik
- Department of Molecular Diagnostics, Holy Cross Cancer Center, 25-734 Kielce, Poland;
- Division of Medical Biology, Institute of Biology, Jan Kochanowski University, 25-406 Kielce, Poland
| | - Joanna Streb
- Department of Oncology, Jagiellonian University Medical College, 31-008 Krakow, Poland;
| | - Mariusz Bidziński
- Department of Gynecological Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.Z.-S.); (A.R.); (M.B.)
| | - Włodzimierz Sawicki
- Department of Obstetrics and Gynecological Oncology, Medical University of Warsaw, 02-091 Warsaw, Poland;
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Balan L, Rusu EL, Ciurescu S, Larisa TV, Secosa C, Potre C, Balulescu L, Brasoveanu S, Balica MA, Pirtea L. Feasibility and Diagnostic Accuracy of Ultrastaging in the Detection of Micrometastases in Sentinel and Non-sentinel Lymph Nodes in Cervical Cancer: A Single-Center Retrospective Study With a Five-Year Follow-Up Period. Cureus 2024; 16:e61336. [PMID: 38947581 PMCID: PMC11214644 DOI: 10.7759/cureus.61336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND Cervical cancer is the fourth most common cause of malignant tumor-related deaths among women in developing nations. Cervical cancer has been estimated to cause 527.600 new cases and 265.700 deaths globally per year. OBJECTIVES This study aimed to evaluate patients with cervical cancer by ultrastaging all the lymph nodes (LN), sentinel LN (SLN) and non-SLN, to increase the sensitivity of the detection of LN metastases and the diagnostic accuracy in cervical cancer with a five-year follow-up. MATERIALS AND METHODS This is a retrospective study of 14 cervical cancer cases from 2017 to 2019 at the Municipal Emergency Clinical Hospital of Timisoara, Romania. The cases were selected based on their high risk of LN involvement but negative intraoperative pathologic LN. After re-evaluating all paraffin block biopsy samples from 29 cases, 14 cases were included in the study, which met all criteria for ultrastaging on surgical biopsy samples. RESULTS Patients' ages included in the study ranged from 43 to 70 years (median: 57.14 years). According to the International Federation of Gynecology and Obstetrics (FIGO) staging, the majority of the patients were in stage IB: seven cases (50%). The study revealed a positive correlation between patient age and FIGO staging, with Pearson's correlation coefficient of 0.707 and a p-value of less than 0.05, indicating that older patients were more likely to be diagnosed with a higher FIGO stage. The mean follow-up was 34.5 months, and the median follow-up was 36 months (range: 6-60 months). We obtained 167 nodes, with a mean of 11.92 nodes/case. Twenty-one LN were found to be positive with the ultrastaging method. We detected 11 LN with macrometastases (MAC) (52.38%), seven with micrometastasis (MIC) (33.3%), and three with tumor cell islets (14.4%). That would be 13% of newly diagnosed ultrastaging cases as positive nodes. This ultrastaging method detected nodal MIC in eight (57.1%) out of the 14 patients, who initially tested negative for LN involvement using the routine Hematoxylin and Eosin (HE) method. The detection of micrometastases in these patients underscored the superior sensitivity of ultrastaging, which was further highlighted by the subsequent relapse of four (28.57%) out of these eight patients. The study also found no correlation between the FIGO standardization and the number of MIC found in these patients. CONCLUSIONS Predicting cervical LN metastasis (LNM) is crucial for improving survival rates and reducing recurrence. Very few small cohort studies used an ultrastaging method to assess non-SLNs; most of them only assessed SLNs. We showed in our study that the ultrastaging method, both in the case of SLN and non-SLN, is superior compared with H&E analysis, with a 13% rate of new positive nodule diagnosis. Metastatic involvement of non-SLN was found in over 50% of all cases (8/14) according to the ultrastaging method. Additionally, our study confirms that the sensitivity of SLN ultrastaging is high for the presence of both MIC and MAC in SLN pelvic LN. As a result, we feel that ultrastaging is the most effective method for SLN analysis in patients with early-stage cervical cancer, and bilateral detection is preferable, significantly reducing false-negative results. The routine use of SLN along with ultrastaging would lead to more accurate surgical staging and better oncological follow-up of cases.
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Affiliation(s)
- Lavinia Balan
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, ROU
| | - Elena Lavinia Rusu
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, ROU
| | - Sebastian Ciurescu
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, ROU
| | - Tomescu V Larisa
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, ROU
| | - Cristina Secosa
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, ROU
| | - Cristina Potre
- Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, ROU
| | - Ligia Balulescu
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, ROU
| | - Simona Brasoveanu
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, ROU
| | | | - Laurentiu Pirtea
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, ROU
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[Carbon nanoparticle tracing of sentinel lymph nodes in diagnosis and treatment of cervical cancer and clinical value of lymph node ultrastaging detection]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2022; 42:1896-1901. [PMID: 36651260 PMCID: PMC9878409 DOI: 10.12122/j.issn.1673-4254.2022.12.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the clinical value of sentinel lymph node (SLN) detection using carbon nanoparticles in the diagnosis and treatment of cervical cancer and the value of lymph node pathological ultrastaging detection. METHODS A total of 79 patients with cervical cancer in IA2, IB1, IB2, IIA1 and IIICp1 stages admitted to the Department of Gynecology and Obstetrics, Nanfang Hospital between June, 2018 and January, 2021 were included in this study. During the operation, the patients were injected with a total of 0.25 mL carbon nanoparticles at 3 and 9 o'clock of the normal cervix after general anesthesia. The first black-dyed lymph nodes were identified as SLNs and removed one by one. All the patients underwent pelvic lymph node dissection and radical hysterectomy with or without para-aortic lymphadenectomy. The black-dyed SLNs were removed for routine pathological examination. Thirty patients with negative SLNs were randomly selected for pathological ultrastaging. RESULTS In 67 of the 79 patients, a total of 417 SLNs were detected with a detection rate of 84.8%; in each patient, at least 1 SLN was detected with a mean SLN number of 5.28. After the operation, 5 patients were found to have positive SLNs; 1 patient was negative for SLN but positive for non-SLN. The sensitivity of SLN biopsy was 83.3% with a specificity of 100%, false negative rate of 16.7%, an accuracy of 98.5% and a negative predictive value of 98.4%. SLN was distributed mainly in the obturator region, the external iliac region, the internal iliac region and the total iliac region (15.11%). Univariate and multivariate analyses suggested that preoperative cervical coning (P=0.045 and 0.009) and tumor size (P=0.033 and 0.008) significantly affected the overall detection rate of SLN. Kappa test showed a high consistency between SLN and pelvic lymph node metastasis status (Kappa value=0.901, P < 0.001). In 30 patients with negative pathological results of SLN, pathological ultrastaging detection identified no micrometastases or isolated tumor cells. CONCLUSION Carbon nanoparticle tracing of the SLNs is safe and feasible in the diagnosis and treatment of cervical cancer, and SLN detection is safe in patients with primary lesion size below 2 cm or without cervical conization. SLN combined with pathological ultrastaging detection does not improve the detection rate of isolated tumor cells or micrometastases.
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Koutroumpa I, Diakosavvas M, Sotiropoulou M, Pergialiotis V, Angelou K, Liontos M, Haidopoulos D, Bamias A, Rodolakis A, Thomakos N. Identification and Biopsy of Sentinel Lymph Node in Early-Stage Cervical Carcinoma: Diagnostic Accuracy and Clinical Utility. Cureus 2022; 14:e23838. [PMID: 35530888 PMCID: PMC9070105 DOI: 10.7759/cureus.23838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/05/2022] Open
Abstract
Background Due to the subsequent complications of pelvic lymphadenectomy in patients with early-stage cervical cancer, the sentinel lymph node (SLN) technique has been increasingly employed. This study aimed to investigate the detectability of SLN using methylene blue and explore the diagnostic accuracy of SLN biopsy. Methodology A study was conducted from September 2015 to August 2018 and included 90 women with cervical cancer, FIGO (International Federation of Gynecology and Obstetrics-2009) stage IA1-IIA1. Methylene blue was injected intracervically. Any detected dyed nodes were sent for frozen section biopsy, followed by bilateral pelvic lymphadenectomy. The predictive ability of SLN was evaluated in statistical terms after comparison of intraoperative biopsy and final histopathology. Results The sensitivity, specificity, false-negative rate, positive predictive value, and negative predictive value (NPV) were 55.6%, 95.1%, 4.9%, 55.6%, and 95.1%, respectively. The SLN performance in patients with tumor size ≤2.2 cm, negative lymphovascular space involvement, and depth of stromal invasion ≤5 mm was superior (sensitivity 100%, specificity 93.5%, NPV 100%). Conclusions The SLN technique with blue dye alone is a feasible and adequate alternative to systematic lymphadenectomy in early-stage cervical cancer in selected patients, given that a strict algorithm is applied.
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Affiliation(s)
- Ioanna Koutroumpa
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Michail Diakosavvas
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Maria Sotiropoulou
- Department of Pathology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Vasilios Pergialiotis
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Kyveli Angelou
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Michalis Liontos
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Dimitrios Haidopoulos
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Aristotelis Bamias
- 2nd Propaedeutic Department of Internal Medicine, Attikon Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Alexandros Rodolakis
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Nikolaos Thomakos
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
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Beckmann MW, Stuebs FA, Vordermark D, Koch MC, Horn LC, Fehm T. The Diagnosis, Treatment, and Aftercare of Cervical Carcinoma. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:806-812. [PMID: 34755595 DOI: 10.3238/arztebl.m2021.0352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 08/16/2021] [Accepted: 10/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Approximately 4380 cases of cervical carcinoma were diagnosed in Germany in 2016. In women who had not participated in early detection programs, cervical carcinoma was usually already in an advanced stage at the time of diagnosis. Certified structures for care in conformity with the existing guidelines are available. METHODS The new German clinical practice guideline was revised with the participation of 50 medical societies under the expert guidance of the Guideline Program in Oncology, which includes the German Association of the Scientific Medical Societies (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF). A systematic literature review was conducted. Systematic reviews, meta-analyses, and randomized controlled trials (RCTs) were considered. RESULTS The histologic tumor stage and lymph-node stage are essential determinants of the treatment strategy. The main innovation regarding surgical treatment is the revival of open hysterectomy (overall survival [minimally invasive vs open hysterectomy]: 94.04% vs 99.4%; hazard ratio [HR]: 6.00; 95% confidence interval [1.77; 20.30]). In addition, for tumors measuring 2 cm or less, sentinel node biopsy is recommended rather than radical pelvic lymphadenectomy. MRI-guided brachytherapy is an obligatory component of radiochemotherapy (overall survival [radiochemotherapy with vs without brachytherapy]: 58.2% vs 46.2%, p<0.001). The standard palliative treatment consists of bevacizumab combined with a platinum-containing agent (overall survival: HR: 0.77 [0.62; 0.95]; p = 0.007). CONCLUSION Despite the introduction of new treatments, the outcome of patients with advanced cervical carcinoma has not much improved. In the surgical treatment of cervical carcinoma, the open approach is now favored. The sentinel node biopsy technique has become well established for the surgical staging of small tumors. Controlled trials are needed so that the outcome of women with cervical carcinoma, particularly in its advanced and metastatic stages, can be improved.
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Clinical Study of Sentinel Lymph Node Detection Using Photodynamic Eye for Abdominal Radical Trachelectomy. Curr Oncol 2021; 28:4709-4720. [PMID: 34898550 PMCID: PMC8628807 DOI: 10.3390/curroncol28060397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/01/2021] [Accepted: 11/13/2021] [Indexed: 12/24/2022] Open
Abstract
This study aimed to assess the accuracy of predicting pelvic lymph node status using sentinel lymph node (SLN) biopsy with indocyanine green (ICG) and to examine the outcomes of SLN biopsy-guided abdominal radical trachelectomy (ART). Patients with stage IA2-IB2 cervical cancer from January 2009 to January 2021 were included. ICG was injected before ART and SLNs were identified, excised, and assessed intraoperatively using fast-frozen sections. Systemic pelvic lymphadenectomy was subsequently performed. The SLN detection rate, sensitivity, and false-negative rate were determined. Thirty patients desiring fertility preservation were enrolled, of whom 26 successfully completed ART and four underwent radical hysterectomies because of metastatic primary SLNs. Bilateral SLNs were identified in all patients. The sensitivity, false-negative rate, and negative predictive value were 100%, 7.7%, and 92.3%, respectively. Three (12%) patients were lost to follow-up: two relapsed and one died of tumor progression. Of the nine patients who tried to conceive after surgery, four achieved pregnancy and three delivered healthy live infants. In women with early-stage cervical cancer who desired to conserve fertility, SLN mapping with ICG had a very high detection rate, sensitivity, and low false-negative rate. SLN biopsy-guided ART is a feasible and accurate method for assessing pelvic node status.
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Sentinel lymph node biopsy and morbidity outcomes in early cervical cancer: Results of a multicentre randomised trial (SENTICOL-2). Eur J Cancer 2021; 148:307-315. [PMID: 33773275 DOI: 10.1016/j.ejca.2021.02.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/24/2021] [Accepted: 02/02/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Pelvic lymph node dissection has been the standard of care for patients with early cervical cancer. Sentinel node (SN) mapping is safe and feasible and may increase the detection of metastatic disease, but benefits of omitting pelvic lymph node dissection in terms of decreased morbidity have not been demonstrated. MATERIALS AND METHODS In an open-label study, patients with early cervical carcinoma (FIGO 2009 stage IA2 to IIA1) were randomly assigned to SN resection alone (SN arm) or SN and pelvic lymph node dissection (SN + PLND arm). SN resection was followed by radical surgery of the tumour (radical hysterectomy or radical trachelectomy). The primary end-point was morbidity related to the lymph node dissection; 3-year recurrence-free survival was a secondary end-point. RESULTS A total of 206 patients were eligible and randomly assigned to the SN arm (105 patients) or SN + PLND arm (101 patients). Most patients had stage IB1 lesion (87.4%). No false-negative case was observed in SN + PLND arm. Lymphatic morbidity was significantly lower in the SN arm (31.4%) than in the SN + PLND arm (51.5%; p = 0.0046), as was the rate of postoperative neurological symptoms (7.8% vs. 20.6%, p = 0.01, respectively). However, there was no significant difference in the proportion of patients with significant lymphoedema between the two groups. During the 6-month postoperative period, the difference in morbidity decreased over time. The 3-year recurrence-free survival was not significantly different (92.0% in SN arm and 94.4% in SN + PLND arm). CONCLUSION SN resection alone is associated with early decreased lymphatic morbidity when compared with SN + PLND in early cervical cancer.
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Park KJ, Roma A, Singh N, Gilks CB, Oliva E, Abu-Rustum N, Ramirez PT, McCluggage WG. Tumor Staging of Endocervical Adenocarcinoma: Recommendations From the International Society of Gynecological Pathologists. Int J Gynecol Pathol 2021; 40:S92-S101. [PMID: 33570866 PMCID: PMC7969160 DOI: 10.1097/pgp.0000000000000758] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The International Federation of Gynecology and Obstetrics (FIGO) updated its staging system for cervical cancer in 2018 with changes that affect size criteria for early stage disease, as well as including pathology and radiology in addition to clinical assessment to be used in staging. Lymph node involvement was also included in the staging system. In early stage disease, pathologic findings are crucial in determining stage, which in turn determine treatment and prognosis for the patient. Therefore, it is imperative that there are unified and consistent methods and recommendations for assessing and reporting pathologic parameters for accurate staging. We describe the changes in the revised FIGO staging scheme and discuss controversial issues in cervical cancer staging from a pathologic perspective. We also provide practical recommendations regarding these parameters based on literature review and/or expert opinion/consensus.
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Sentinel Node Imaging and Radioguided Surgery in the Era of SPECT/CT and PET/CT: Toward New Interventional Nuclear Medicine Strategies. Clin Nucl Med 2020; 45:771-777. [PMID: 32701805 DOI: 10.1097/rlu.0000000000003206] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We review recent technological advances and new clinical indications for sentinel node (SN) and radioguided surgery in order to delineate future tendencies of interventional nuclear medicine in this field. A literature research was performed in PubMed to select relevant articles to be used as key references for analysis of the current approaches and tendencies in SN and radioguided surgery, as well as the evolving contribution of nuclear medicine intervention techniques to the various clinical applications. For classic indications such as melanoma and breast cancer, the incorporation of the SN approach based on the combined use of existing and new preoperative and intraoperative technologies in high-risk patient categories is becoming an emerging area of clinical indication. For SN biopsy staging in other malignancies with more complex lymphatic drainage, the incorporation of sophisticated tools is most helpful. The consecutive use of PET/CT and the SN procedure is increasing as a potential combined approach for the management of specific areas such as the axilla and the pelvis in patients at high risk of regional dissemination. Also, for the management of locoregional metastasis and oligometastatic disease, interventional nuclear medicine techniques are becoming valuable alternatives. The extended experience with SN biopsy is leading to technological advances facilitating the incorporation of this procedure to stage other malignancies with complex lymphatic drainage. New nuclear medicine-based approaches, incorporating SPECT/CT and PET/CT to guide resection of SNs and occult metastases, have recently been gaining ground.
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Reed N, Balega J, Barwick T, Buckley L, Burton K, Eminowicz G, Forrest J, Ganesan R, Harrand R, Holland C, Howe T, Ind T, Iyer R, Kaushik S, Music R, Sadozye A, Shanbhag S, Siddiqui N, Syed S, Percival N, Whitham NL, Nordin A, Fotopoulou C. British Gynaecological Cancer Society (BGCS) cervical cancer guidelines: Recommendations for practice. Eur J Obstet Gynecol Reprod Biol 2020; 256:433-465. [PMID: 33143928 DOI: 10.1016/j.ejogrb.2020.08.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/05/2020] [Accepted: 08/21/2020] [Indexed: 01/20/2023]
Abstract
Cervix cancer in many countries is declining and screening programmes and immunisation will reduce the incidence in the next few decades. This guideline attempts to cover management of invasive disease reflecting diagnosis and imaging including new imaging and sentinel lymph node biopsies. Smaller volume disease is usually managed surgically whereas advanced disease is treated with (chemo)- radiation. It also includes discussion of fertility sparing procedures. Practices are changing frequently for all aspects of care usually in attempts to reduce complications and improve quality of life. The management of advanced disease is treated by chemotherapy and the use of newer agents is also discussed. Other sections discuss specialist situations such as cancer in pregnancy, rare cervical tumours, late effects and supportive measures and fertility preserving approaches.
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Affiliation(s)
- Nick Reed
- Beatson Oncology Centre, Glasgow, United Kingdom.
| | | | | | - Lynn Buckley
- Clinical Nurse Specialist, Hull University Teaching Hospitals NHS Trust, United Kingdom
| | | | | | | | | | | | | | | | - Thomas Ind
- Royal Marsden Hospital, London, United Kingdom
| | - Rema Iyer
- East Kent Hospitals University Foundation NHS Trust, United Kingdom
| | | | - Robert Music
- Jo's Cervical Cancer Trustt, London, United Kingdom
| | | | - Smruta Shanbhag
- University Hospitals Coventry and Warwickshire NHS Trust, United Kingdom
| | | | - Sheeba Syed
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | | | - Natasha Lauren Whitham
- Lancashire Teaching Hospitals (Royal Preston Hospital, Fulwood, Lancashire), United Kingdom
| | - Andy Nordin
- East Kent Gynaecological Oncology Centre, East Kent Hospitals University Foundation Nhs Trust, Queen Elizabeth The Queen Mother Hospital, Margate, United Kingdom
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Wang Y, Dan Z, Yuan G, Zhang G, Liu S, Zhang Y, Li B. Detection of sentinel lymph node in laparoscopic surgery for uterine cervical cancer using carbon nanoparticles. J Surg Oncol 2020; 122:934-940. [PMID: 32614998 DOI: 10.1002/jso.26100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/22/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Carbon nanoparticles (CNPs) has been widely confirmed the efficiency in sentinel lymph node (SLN) mapping for various solid tumors. This study aims to explore the feasibility and effectiveness of CNPs during laparoscopic surgery for cervical cancer. METHODS We analyzed 45 women with stage IB1-IIA1 cervical cancer who underwent SLN mapping using CNPs during laparoscopic surgery. The effectiveness of CNPs was evaluated by the detection rate and accuracy parameters. Factors associated with SLN laterality and SLNs localizations were analyzed. RESULTS The overall and bilateral detection rate was 93.3% (42/45) and 60.0% (27/45), respectively. Elevated body mass index was associated with decreased bilateral detection rate (P = .015). A total of 225 SLNs were harvested, with a mean number of 5.0 ± 3.6. A total of 81.3% of SLNs were in expected localizations including external iliac (39.1%), internal iliac (25.8%), and obturator (16.4%) regions, while 18.7% in unusual localizations including common iliac (10.7%), parametrial (7.6%), and presarcal (0.4%) regions. None positive lymph node was found in non-SLNs with a false-negative rate of 0%. CONCLUSION Laparoscopic SLN mapping with CNPs appears to be simple and efficient for patients with early-stage cervical cancer.
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Affiliation(s)
- Yating Wang
- Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhao Dan
- Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guangwen Yuan
- Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gongyi Zhang
- Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuanghuan Liu
- Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanan Zhang
- Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Li
- Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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12
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Nemejcova K, Kocian R, Kohler C, Jarkovsky J, Klat J, Berjon A, Pilka R, Sehnal B, Gil-Ibanez B, Lupo E, Petiz A, Arencibia Sanchez O, Kascak P, Martinelli F, Buda A, Presl J, Barahona M, van Lonkhuijzen L, Szatkowski W, Minar L, Pakiz M, Havelka P, Zorrero C, Misiek M, Snyman LC, Wydra D, Vergote I, Vinnytska A, Redecha M, Michal M, Tingulstad S, Kipp B, Szewczyk G, Toth R, de Santiago Garcia FJ, Coronado Martin PJ, Poka R, Tamussino K, Luyckx M, Fastrez M, Staringer JC, Germanova A, Plaikner A, Bajsova S, Dundr P, Mallmann-Gottschalk N, Cibula D. Central Pathology Review in SENTIX, A Prospective Observational International Study on Sentinel Lymph Node Biopsy in Patients with Early-Stage Cervical Cancer (ENGOT-CX2). Cancers (Basel) 2020; 12:cancers12051115. [PMID: 32365651 PMCID: PMC7281480 DOI: 10.3390/cancers12051115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/23/2020] [Accepted: 04/25/2020] [Indexed: 02/07/2023] Open
Abstract
The quality of pathological assessment is crucial for the safety of patients with cervical cancer if pelvic lymph node dissection is to be replaced by sentinel lymph node (SLN) biopsy. Central pathology review of SLN pathological ultrastaging was conducted in the prospective SENTIX/European Network of Gynaecological Oncological Trial (ENGOT)-CX2 study. All specimens from at least two patients per site were submitted for the central review. For cases with major or critical deviations, the sites were requested to submit all samples from all additional patients for second-round assessment. From the group of 300 patients, samples from 83 cases from 37 sites were reviewed in the first round. Minor, major, critical, and no deviations were identified in 28%, 19%, 14%, and 39% of cases, respectively. Samples from 26 patients were submitted for the second-round review, with only two major deviations found. In conclusion, a high rate of major or critical deviations was identified in the first round of the central pathology review (28% of samples). This reflects a substantial heterogeneity in current practice, despite trial protocol requirements. The importance of the central review conducted prospectively at the early phase of the trial is demonstrated by a substantial improvement of SLN ultrastaging quality in the second-round review.
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Affiliation(s)
- Kristyna Nemejcova
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (K.N.); (P.D.)
| | - Roman Kocian
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (R.K.); (A.G.)
| | - Christhardt Kohler
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, 22763 Hamburg, Germany; (C.K.); (A.P.)
| | - Jiri Jarkovsky
- Institute for Biostatistics and Analyses, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic;
| | - Jaroslav Klat
- Department of Obstetrics and Gynecology, University Hospital Ostrava, 708 52 Ostrava Poruba, Czech Republic; (J.K.); (S.B.)
| | - Alberto Berjon
- Department of Pathology, La Paz University Hospital, 28046 Madrid, Spain;
- Molecular Pathology and Therapeutic Targets Group, IdiPAZ, 28046 Madrid, Spain
| | - Radovan Pilka
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc, 77520 Olomouc, Czech Republic;
| | - Borek Sehnal
- Department of Obstetrics and Gynecology, Bulovka Hospital, First Faculty of Medicine, Charles University, 18081 Prague, Czech Republic;
| | - Blanca Gil-Ibanez
- Unit of Gynecological Oncology, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona, 08036 Barcelona, Spain;
| | - Ezequiel Lupo
- Department of Pathology, Institute of Oncology Angel H. Roffo, University of Buenos Aires, Buenos Aires Autonomous City 1214, Argentina;
| | - Almerinda Petiz
- Department of Gynecology, Francisco Gentil Portuguese Oncology Institute, 4200-072 Porto, Portugal;
| | - Octavio Arencibia Sanchez
- Departments of Gynecologic Oncology, University Hospital of the Canary Islands, 35016 Las Palmas de Gran Canaria, Spain;
| | - Peter Kascak
- Department of Obstetrics and Gynecology, Faculty Hospital Trencin, 91171 Trencin, Slovakia;
| | - Fabio Martinelli
- IRCCS Foundation National Cancer Institute in Milan, 20133 Milan, Italy;
| | - Alessandro Buda
- Department of Obstetrics and Gynecology, Unit of Gynecologic Oncology Surgery, San Gerardo Hospital, 20900 Monza, Italy;
| | - Jiri Presl
- Department of Gynaecology and Obstetrics, University Hospital Pilsen, Charles University, 30460 Prague, Czech Republic;
| | - Marc Barahona
- Department of Gynecology, University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge, University of Barcelona, 08907 Barcelona, Spain;
| | - Luc van Lonkhuijzen
- Center for Gynecologic Oncology, Academic Medical Centre, 1100DD Amsterdam, The Netherlands;
| | - Wiktor Szatkowski
- Department of Gynecologic Oncology, Centre of Oncology, M. Sklodowska-Curie Memorial Institute, Cracow Department, 31-115 Cracow, Poland;
| | - Lubos Minar
- Department of Gynecology and Obstetrics, Faculty of Medicine, Masaryk University, 60200 Brno, Czech Republic;
| | - Maja Pakiz
- University Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, 2000 Maribor, Slovenia;
| | | | - Cristina Zorrero
- Gynecology Department, Instituto Valenciano de Oncología (IVO), 46009 Valencia, Spain;
| | - Marcin Misiek
- Department of Gynecologic Oncology, Holycross Cancer Center, 25-734 Kielce, Poland;
| | - Leon Cornelius Snyman
- Gynaecologic Oncology Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria 0001, South Africa;
| | - Dariusz Wydra
- Department of Gynecology, Gynecologic Oncology and Gynecologic Endocrinology, Medical University of Gdansk, 80-402 Gdansk, Poland;
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, University Hospital Leuven, Leuven Cancer Institute, 3000 Leuven, Belgium;
| | - Alla Vinnytska
- LISOD-Israeli Oncological Hospital, 08720 Plyuty, Ukraine;
| | - Mikulas Redecha
- Department of Gynaecology and Obstetrics, University Hospital, Comenius University, 82101 Bratislava, Slovakia;
| | - Martin Michal
- Department of Obstetrics and Gynaecology, Hospital Ceske Budejovice, JSC, 37001 Ceske Budejovice, Czech Republic;
| | | | - Barbara Kipp
- Department of Obstetrics and Gynecology, Cantonal Hospital of Lucerne, 6000 Lucerne, Switzerland;
| | - Grzegorz Szewczyk
- Department of Obstetrics and Gynecology, Institute of Mother and Child, 01-211 Warsaw, Poland;
| | - Robert Toth
- Oncology Institute of East Slovakia, 04191 Košice, Slovakia;
| | | | | | - Robert Poka
- Institute of Obstetrics and Gynaecology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
| | | | - Mathieu Luyckx
- Department of Gynecology, Universite catholique de Louvain, Cliniques Universitaires St Luc, 1200 Brussels, Belgium;
| | - Maxime Fastrez
- Department of Obstetrics and Gynaecology, St Pierre University Hospital, Universite Libre de Bruxelles, 1000 Brussels, Belgium;
| | - Juan Carlos Staringer
- Department of Gynecology and Obstetrics, Hospital Español de Buenos Aires, Buenos Aires 2975, Argentina;
| | - Anna Germanova
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (R.K.); (A.G.)
| | - Andrea Plaikner
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, 22763 Hamburg, Germany; (C.K.); (A.P.)
| | - Sylva Bajsova
- Department of Obstetrics and Gynecology, University Hospital Ostrava, 708 52 Ostrava Poruba, Czech Republic; (J.K.); (S.B.)
| | - Pavel Dundr
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (K.N.); (P.D.)
| | | | - David Cibula
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (R.K.); (A.G.)
- Correspondence: ; Tel.: +420-224967451
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13
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Dundr P, Cibula D, Němejcová K, Tichá I, Bártů M, Jakša R. Pathologic Protocols for Sentinel Lymph Nodes Ultrastaging in Cervical Cancer. Arch Pathol Lab Med 2019; 144:1011-1020. [PMID: 31869245 DOI: 10.5858/arpa.2019-0249-ra] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Ultrastaging of sentinel lymph nodes (SLNs) is a crucial aspect in the approach to SLN processing. No consensual protocol for pathologic ultrastaging has been approved by international societies to date. OBJECTIVE.— To provide a review of the ultrastaging protocol and all its aspects related to the processing of SLNs in patients with cervical cancer. DATA SOURCES.— In total, 127 publications reporting data from 9085 cases were identified in the literature. In 24% of studies, the information about SLN processing is entirely missing. No ultrastaging protocol was used in 7% of publications. When described, the differences in all aspects of SLN processing among the studies and institutions are substantial. This includes grossing of the SLN, which is not completely sliced and processed in almost 20% of studies. The reported protocols varied in all aspects of SLN processing, including the thickness of slices (range, 1-5 mm), the number of levels (range, 0-cut out until no tissue left), distance between the levels (range, 40-1000 μm), and number of sections per level (range, 1-5). CONCLUSIONS.— We found substantial differences in protocols used for SLN pathologic ultrastaging, which can impact sensitivity for detection of micrometastases and even small macrometastases. Since the involvement of pelvic lymph nodes is the most important negative prognostic factor, such profound discrepancies influence the referral of patients to adjuvant radiotherapy and could potentially cause treatment failure. It is urgent that international societies agree on a consensual protocol before SLN biopsy without pelvic lymphadenectomy is introduced into routine clinical practice.
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Affiliation(s)
- Pavel Dundr
- From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - David Cibula
- From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Kristýna Němejcová
- From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Ivana Tichá
- From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Michaela Bártů
- From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Radek Jakša
- From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
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14
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Bhatla N, Berek JS, Cuello Fredes M, Denny LA, Grenman S, Karunaratne K, Kehoe ST, Konishi I, Olawaiye AB, Prat J, Sankaranarayanan R, Brierley J, Mutch D, Querleu D, Cibula D, Quinn M, Botha H, Sigurd L, Rice L, Ryu HS, Ngan H, Mäenpää J, Andrijono A, Purwoto G, Maheshwari A, Bafna UD, Plante M, Natarajan J. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynaecol Obstet 2019; 145:129-135. [PMID: 30656645 DOI: 10.1002/ijgo.12749] [Citation(s) in RCA: 524] [Impact Index Per Article: 104.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/05/2018] [Accepted: 12/20/2018] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To revise FIGO staging of carcinoma of the cervix uteri, allowing incorporation of imaging and/or pathological findings, and clinical assessment of tumor size and disease extent. METHODS Review of literature and consensus view of the FIGO Gynecologic Oncology Committee and related societies and organizations. RESULTS In stage I, revision of the definition of microinvasion and lesion size as follows. Stage IA: lateral extension measurement is removed; stage IB has three subgroups-stage IB1: invasive carcinomas ≥5 mm and <2 cm in greatest diameter; stage IB2: tumors 2-4 cm; stage IB3: tumors ≥4 cm. Imaging or pathology findings may be used to assess retroperitoneal lymph nodes; if metastatic, the case is assigned stage IIIC; if only pelvic lymph nodes, the case is assigned stage IIIC1; if para-aortic nodes are involved, the case is assigned stage IIIC2. Notations 'r' and 'p' will indicate the method used to derive the stage-i.e., imaging or pathology, respectively-and should be recorded. Routine investigations and other methods (e.g., examination under anesthesia, cystoscopy, proctoscopy, etc.) are not mandatory and are to be recommended based on clinical findings and standard of care. CONCLUSION The revised cervical cancer staging is applicable to all resource levels. Data collection and publication will inform future revisions.
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Affiliation(s)
- Neerja Bhatla
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jonathan S Berek
- Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Mauricio Cuello Fredes
- Division Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Lynette A Denny
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and SAMRC Gynaecology Cancer Research Centre, University of Cape Town, Cape Town, South Africa
| | - Seija Grenman
- University of Turku and Department of Obstetrics and Gynecology, Turku University Hospital, Turku, Finland
| | - Kanishka Karunaratne
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Sean T Kehoe
- University of Birmingham and St. Peters College, Oxford, UK
| | - Ikuo Konishi
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Alexander B Olawaiye
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jaime Prat
- Autonomous University of Barcelona, Barcelona, Spain
| | - Rengaswamy Sankaranarayanan
- International Agency for Research on Cancer (WHO-IARC), Lyon, France
- RTI International India, New Delhi, India
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15
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Glickman AG, Valdes S, Gil-Ibañez B, Paredes P, Cortés KS, Torné Blade AA. Present status of sentinel lymph node biopsy in cervical cancer. Rep Pract Oncol Radiother 2018; 23:495-502. [PMID: 30534012 PMCID: PMC6277279 DOI: 10.1016/j.rpor.2018.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 02/17/2018] [Accepted: 04/08/2018] [Indexed: 02/06/2023] Open
Abstract
Cervical cancer is the fourth most common cancer in women, and seventh overall. This disease represents a medical, economic and social burden. In early FIGO stage patients (IA, IB1 and IIA1), nodal involvement is the most important prognostic factor. Imaging evaluation of nodal metastasis is of limited value. In order to determine lymph node involvement, allow loco-regional control of the disease, define the need for adjuvant radiotherapy and improve survival, standard surgery for early disease is radical hysterectomy with systematic pelvic lymphadenectomy. However, this surgical treatment has risks and complications: longer operative time, larger blood loss, neurovascular or ureteral injury, lower-limb lymphedema, symptomatic lymphocysts, hydronephrosis. A method that allows to define the presence of regional metastasis with less morbidity and equal or greater precision is particularly relevant. The use of the sentinel lymph node biopsy is intended to reach that purpose. The present study reviews recent literature on the role of sentinel lymph node biopsy in cervical cancer, analyzing its indications and contraindications, injection and detection techniques, tracers used, surgical and pathological approaches and its applicability in up-to-date clinical practice.
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Affiliation(s)
- Ariel Gustavo Glickman
- Gynecological Oncology Unit, Barcelona Clinic Hospital, 170 Villaroel St, Barcelona 08036, Spain
| | - Sergio Valdes
- Gynecological Oncology Unit, Barcelona Clinic Hospital, 170 Villaroel St, Barcelona 08036, Spain
| | - Blanca Gil-Ibañez
- Gynecological Oncology Unit, Barcelona Clinic Hospital, 170 Villaroel St, Barcelona 08036, Spain
| | - Pilar Paredes
- Nuclear Medicine, Barcelona Clinic Hospital, 170 Villaroel St, Barcelona 08036, Spain
| | | | - Aureli Angel Torné Blade
- Gynecological Oncology Unit, Barcelona Clinic Hospital, 170 Villaroel St, Barcelona 08036, Spain
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16
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Tanaka T, Sasaki S, Tsuchihashi H, Terai Y, Yamamoto K, Yamada T, Ohmichi M. Which is better for predicting pelvic lymph node metastases in patients with cervical cancer: Fluorodeoxyglucose-positron emission tomography/computed tomography or a sentinel node biopsy? A retrospective observational study. Medicine (Baltimore) 2018; 97:e0410. [PMID: 29668599 PMCID: PMC5916659 DOI: 10.1097/md.0000000000010410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Systematic pelvic lymph node resection may not be needed for patients with cervical cancer, especially in the early stage, if the pre- or intraoperative diagnosis of lymph node status is correct. The aim of this study was to evaluate the diagnostic accuracy of pelvic lymph node metastasis for fluorodeoxyglucose-positron emission tomography/computed tomography (FDG PET/CT) and sentinel node biopsy (SNB) of cervical cancer patients.Forty-eight patients with cervical cancer were imaged with FDG PET/CT before radical hysterectomy and underwent an SNB followed by systematic pelvic lymph node dissection. The diagnostic accuracy for predicting pelvic node metastases for FDG PET/CT and SNB compared with the ultimate histologic status was analyzed.Among 96 hemi-pelvises (HPs) in 48 patients, pelvic lymph node metastases were obtained in 12 HPs. The sensitivity of pelvic node metastases for FDG PET/CT and SNB was 8.3% and 75.0%, respectively. The specificity for FDG PET/CT and SNB was 97.6% and 94.0%, respectively. The negative predictive value for FDG-PET/CT and SNB was 88.2% and 100%, respectively.SNB is more suitable for detecting pelvic node metastases than FDG PET/CT. The omission of systematic pelvic lymphadenectomy should be considered based on the findings of SNB, not FDG PET/CT.
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Affiliation(s)
| | | | | | | | | | - Takashi Yamada
- Department of Pathology, Osaka Medical College, Takatsuki, Osaka, Japan
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17
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Rundle S, Halvorsrud K, Bizzarri N, Ratnavelu NDG, Fisher AD, Ang C, Bryant A, Naik R, Kucukmetin A. Sentinel node biopsy for diagnosis of pelvic lymph node involvement in early stage cervical cancer. Hippokratia 2017. [DOI: 10.1002/14651858.cd007925.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Stuart Rundle
- Northern Gynaecological Oncology Centre; Gynaecological Oncology; Queen Elizabeth Hospital Sheriff Hill Gateshead UK NE9 6SX
| | - Kristoffer Halvorsrud
- Wolfson Institute of Preventive Medicine; Centre for Psychiatry; Barts and The London School of Medicine and Dentistry Queen Mary University of London London UK EC1M 6BQ
| | - Nicolo Bizzarri
- Northern Gynaecological Oncology Centre; Gynaecological Oncology; Queen Elizabeth Hospital Sheriff Hill Gateshead UK NE9 6SX
| | - Nithya DG Ratnavelu
- Northern Gynaecological Oncology Centre; Gynaecological Oncology; Queen Elizabeth Hospital Sheriff Hill Gateshead UK NE9 6SX
| | - Ann D Fisher
- Northern Gynaecological Oncology Centre; Gynaecological Oncology; Queen Elizabeth Hospital Sheriff Hill Gateshead UK NE9 6SX
| | - Christine Ang
- Northern Gynaecological Oncology Centre; Gynaecological Oncology; Queen Elizabeth Hospital Sheriff Hill Gateshead UK NE9 6SX
| | - Andrew Bryant
- Newcastle University; Institute of Health & Society; Medical School New Build Richardson Road Newcastle upon Tyne UK NE2 4AX
| | - Raj Naik
- Northern Gynaecological Oncology Centre; Gynaecological Oncology; Queen Elizabeth Hospital Sheriff Hill Gateshead UK NE9 6SX
| | - Ali Kucukmetin
- Northern Gynaecological Oncology Centre; Gynaecological Oncology; Queen Elizabeth Hospital Sheriff Hill Gateshead UK NE9 6SX
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18
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Cusimano MC, Walker R, Bernardini MQ, Bouchard-Fortier G, Laframboise S, May T, Murphy J, Rosen B, Covens A, Clarke B, Shaw P, Rouzbahman M, Mohan R, Ferguson SE. Implementing a Cervical Sentinel Lymph Node Biopsy Program: Quality Improvement in Gynaecologic Oncology. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:659-667. [DOI: 10.1016/j.jogc.2017.02.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 10/19/2022]
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19
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Ferrandina G, Pedone Anchora L, Gallotta V, Fagotti A, Vizza E, Chiantera V, De Iaco P, Ercoli A, Corrado G, Bottoni C, Fanfani F, Scambia G. Can We Define the Risk of Lymph Node Metastasis in Early-Stage Cervical Cancer Patients? A Large-Scale, Retrospective Study. Ann Surg Oncol 2017; 24:2311-2318. [PMID: 28608117 DOI: 10.1245/s10434-017-5917-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy has emerged as one of the most appreciated techniques for reducing the rate of complete lymph node dissection (LND) performed in patients with early-stage cervical cancer (ECC). However, its performances are still a matter of debate and, to improve them, international guidelines recommend performing at least unilateral LND in case of SLN mapping. In a prior study, we identified a group of patients without evidence of lymph node metastasis (LNM). Our objective is to define a precise risk of LNM for each ECC patient in order to significantly tailor surgery for ECC. METHODS Clinical and pathological data of ECC patients were retrospectively collected by eight Italian institutions. Chi-square test or Fisher's exact test along with logistic regression analysis was used to determine the association of each variable between patients with or without LNM. Results of logistic regression have been used as a basis to calculate the probability to harboring LNM. RESULTS A total of 463 ECC patients were identified. No LNM was detected among the 161 (34.8%) patients who met the criteria and were defined as Very Low Risk. In the other 302 patients, the precise risk of LNM was calculated, and it was <1% in 31 (10.3%) patients. CONCLUSIONS Defining the precise risk of LNM could lead to proper selection of patients in whom any lymph nodal procedure, including SLN, could be avoided.
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Affiliation(s)
- Gabriella Ferrandina
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy. .,Institute of Obstetrics/Gynecology, Catholic University of Sacred Heart, Rome, Italy.
| | - Luigi Pedone Anchora
- Institute of Obstetrics/Gynecology, Catholic University of Sacred Heart, Rome, Italy
| | - Valerio Gallotta
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy
| | - Anna Fagotti
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy.,Institute of Obstetrics/Gynecology, Catholic University of Sacred Heart, Rome, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Oncological Surgery, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Vito Chiantera
- Division of Gynecologic Oncology, Fondazione "Giovanni Paolo II", Campobasso, Italy
| | - Pierandrea De Iaco
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Alfredo Ercoli
- Department of Obstetrics and Gynecology, University of Eastern Piedmond, Novara, Italy
| | - Giacomo Corrado
- Gynecologic Oncology Unit, Department of Oncological Surgery, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Carolina Bottoni
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy
| | - Francesco Fanfani
- Department of Medicine and Aging Sciences, University "G. D'Annunzio", Chieti, Pescara, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy.,Institute of Obstetrics/Gynecology, Catholic University of Sacred Heart, Rome, Italy
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20
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Tanaka T, Terai Y, Ashihara K, Tsunetoh S, Akagi H, Yamada T, Ohmichi M. The detection of sentinel lymph nodes in laparoscopic surgery for uterine cervical cancer using 99m-technetium-tin colloid, indocyanine green, and blue dye. J Gynecol Oncol 2016; 28:e13. [PMID: 27894166 PMCID: PMC5323283 DOI: 10.3802/jgo.2017.28.e13] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 09/28/2016] [Accepted: 10/21/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Our objective was to determine the feasibility and detection rates and clarify the most effective combination of injected tracer types for sentinel lymph node (SLN) mapping in uterine cervical cancer in patients who have undergone laparoscopic surgery or neoadjuvant chemotherapy (NAC). METHODS A total of 119 patients with cervical cancer underwent SLN biopsy at radical hysterectomy using three types of tracers. The various factors related to side-specific detection rate, sensitivity, and false negative (FN) rate were analyzed. RESULTS The SLN detection rates using 99m-technetium ((99m)Tc)-tin colloid, indigo carmine, and indocyanine green (ICG) were 85.8%, 20.2%, and 61.6%, respectively. The patients with ≥2-cm-diameter tumors and those who received NAC had lower detection rates than those with <2-cm-diameter tumors (75.7% vs. 91.5%, p<0.01) and those who did not receive NAC (67.9% vs. 86.3%, p<0.01), respectively. Laparoscopic procedures had a higher detection rate than laparotomy (100.0% vs. 77.1%, p<0.01). No factors significantly affected the sensitivity; however, the patients with ≥2-cm-diameter tumors (86.0% vs. 1.4%, p<0.01), NAC (19.4% vs. 2.2%, p<0.01), and those who underwent laparotomy (7.4% vs. 0%, p<0.01) had an unfavorable FN rate. CONCLUSION Among the examined tracers, (99m)Tc had the highest detection of SLN mapping in patients with uterine cervical cancer. Patients with local advanced cervical cancer with/without NAC treatment might be unsuited for SLN mapping. SLN mapping is feasible and results in an excellent detection rate in patients with <2-cm-diameter cervical cancer. Laparoscopic surgery is the best procedure for SLN detection in patients with early-stage disease.
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Affiliation(s)
- Tomohito Tanaka
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
| | - Yoshito Terai
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan.
| | - Keisuke Ashihara
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
| | - Satoshi Tsunetoh
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
| | - Hiroyuki Akagi
- Department of Radiology, Osaka Medical College, Osaka, Japan
| | - Takashi Yamada
- Department of Pathology, Osaka Medical College, Osaka, Japan
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
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The sentinel node procedure in early stage cervical cancer, taking the next step; a diagnostic review. Gynecol Oncol 2015; 139:559-67. [DOI: 10.1016/j.ygyno.2015.09.076] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 09/23/2015] [Accepted: 09/24/2015] [Indexed: 12/31/2022]
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