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Persson J, Lührs O, Geppert B, Ekdahl L, Lönnerfors C. A prospective study evaluating an optimized sentinel node algorithm in early stage cervical cancer: The PROSACC-study. Gynecol Oncol 2024; 187:178-183. [PMID: 38788515 DOI: 10.1016/j.ygyno.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE A single center prospective non-randomized study to assess a systematically developed anatomically-based sentinel lymph node (SLN) algorithm in cervical cancer. METHODS Consecutive women with FIGO 2009 stage 1A2-2A1 cervical cancer undergoing robotic radical hysterectomy/trachelectomy between September 2014 and January 2023 had cervically injected Indocyanine Green (ICG) as a tracer for detection of pelvic SLN. An anatomically based surgical algorithm was adhered to; defining SLNs as the juxtauterine mapped nodes within the upper and lower paracervical lymphatic pathways including separate removal of the parauterine lymphovascular tissue (PULT). A completion pelvic lymphadenectomy was performed. Ultrastaging and immunohistochemistry was performed on SLNs, including the PULT. RESULTS 181 women were included for analysis. Median histologic tumor size was 14.0 mm (range 2-80 mm). The bilateral mapping rate was 98.3%. As per protocol an interim analysis rejected H0 and inclusion stopped at 29 node positive women, all identified by at least one metastatic ICG-defined SLN. One woman awaiting histology at study-closure was node positive and included in the analysis. Sensitivity was 100% (95% CI, 88.4%-100%) and NPV 100% (95% CI, 97.6%-100%). In node positive women, the proximal obturator position harbored 46.1% of all SLN metastases representing the only position in 40% and 10% had isolated metastases in the PULT. CONCLUSIONS Strictly adhering to an anatomically based SLN-algorithm including identification of parallell lymphatics within major pathways, partilularly the obturator compartment, assessment of the PULT, restricting nodal dissection to the removal of SLNs accurately identifies pelvic nodal metastatic disease in early-stage cervical cancer.
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Affiliation(s)
- Jan Persson
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Skåne University Hospital, Lund University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology, 22185 Lund, Sweden.
| | - Oscar Lührs
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Skåne University Hospital, Lund University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology, 22185 Lund, Sweden
| | - Barbara Geppert
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Skåne University Hospital, Lund University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology, 22185 Lund, Sweden
| | - Linnea Ekdahl
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Skåne University Hospital, Lund University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology, 22185 Lund, Sweden
| | - Celine Lönnerfors
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Skåne University Hospital, Lund University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology, 22185 Lund, Sweden
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Zhou F, Qi B. Endometrial cancer intraoperative sentinel lymph node identification can effectively guide treatment. Am J Transl Res 2023; 15:6115-6121. [PMID: 37969178 PMCID: PMC10641342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/15/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE To explore the significance of intraoperative sentinel lymph node (SLN) identification in endometrial cancer. METHODS We retrospectively analyzed the clinical data of 56 patients with intraoperative SLN recognition (group A) and 50 patients without intraoperative SLN recognition (group B). SLN and pelvic abdominal lymph node distribution, SLN recognition rate, SLN recognition effect, mortality, the incidence of adverse events, and cumulative survival rate were statistically analyzed. RESULTS SLN were identified and removed in 41 of the 56 patients, with a recognition rate of 82.14% (46/56). The sensitivity of SLN was 83.72%, the specificity was 84.62%, and the negative predictive value was 61.11%. There were 15 patients with no SLN metastasis found in the pathological examination during the operation, among which two patients with poorly differentiated adenocarcinoma and clinical stage II patients underwent immunohistochemical staining, and three patients showed SLN micro-metastasis but no cancer tissue metastasis in the lymph node dissection. There was no significant difference in the incidence of total adverse events between group A and group B (P>0.05). The cumulative survival rate of group A was higher than that of group B (P=0.018). CONCLUSION Intraoperative SLE identification can avoid false negative results, is safe and feasible, and can prolong the survival time of patients with endometrial cancer.
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Affiliation(s)
- Fanchen Zhou
- Department of Gynecology, Dalian Central HospitalDalian, Liaoning, China
| | - Bangruo Qi
- Department of Obstetrics and Gynecology, Sanya Women and Children’s HospitalSanya, Hainan, China
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Xie S, Zhao J, Wang X, Hu Y, Feng G, Zhu H, Wang C. The distribution pattern of pelvic lymph nodal metastases in cervical cancer. J Cancer Res Clin Oncol 2023; 149:9671-9677. [PMID: 37237167 PMCID: PMC10423117 DOI: 10.1007/s00432-023-04810-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023]
Abstract
PURPOSE Depiction of pelvic lymph node metastasis (LNM) sites among patients with cervical cancer facilitates accurate determination of the extent of dissection and radiotherapy regimens. METHODS A retrospective study of 1182 cervical cancer patients who underwent radical hysterectomy and pelvic lymph node dissection between 2008 and 2018 was performed. The number of removed pelvic lymph nodes and metastasis status in different anatomical regions was analyzed. The prognostic difference of patients with lymph node involvement stratified by various factors was analyzed by Kaplan-Meier method. RESULTS The median number of pelvic lymph nodes detected was 22, mainly from obturator (29.54%) and inguinal (21.14%) sites. Metastatic pelvic lymph nodes were found in 192 patients, with obturator accounting for the highest percentage (42.86%). The patients with lymph node involvement in single site had better prognosis that those in multiple sites. The overall- (P = 0.021) (OS) and progression-free (P < 0.001) survival (PFS) curves of patients with inguinal lymph node metastases were worse compared to those with obturator site. There was no difference in the OS and PFS among patients with 2 and more than 2 lymph nodes involvement. CONCLUSION An explicit map of LNM in patients with cervical cancer was presented in this study. Obturator lymph nodes tended to be involved. The prognosis of patients with inguinal lymph node involvement was poor in contrast to that with obturator LNM. In patients with inguinal lymph node metastases, clinical staging needs to be reconsidered and extended radiotherapy to the inguinal region needs to be strengthened.
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Affiliation(s)
- Shangdan Xie
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, 2699 Gaoke West Road, Shanghai, 200092 China
| | - Jing Zhao
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, 2699 Gaoke West Road, Shanghai, 200092 China
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035 China
| | - Xintao Wang
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, 2699 Gaoke West Road, Shanghai, 200092 China
| | - Yan Hu
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035 China
| | - Guannan Feng
- Department of Gynecology, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, 211166 China
| | - Haiyan Zhu
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, 2699 Gaoke West Road, Shanghai, 200092 China
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035 China
| | - Chao Wang
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, 2699 Gaoke West Road, Shanghai, 200092 China
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Wang T, Xu Y, Shao W, Wang C. Sentinel Lymph Node Mapping: Current Applications and Future Perspectives in Gynecology Malignant Tumors. Front Med (Lausanne) 2022; 9:922585. [PMID: 35847801 PMCID: PMC9276931 DOI: 10.3389/fmed.2022.922585] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/30/2022] [Indexed: 12/17/2022] Open
Abstract
The sentinel lymph nodes (SLNs) is a group of lymph nodes initially involved in the metastatic spread of cancer cells. SLN mapping refers to intraoperative localization and biopsy of SLNs with specific tracers to assess lymph node metastases. It is widely used in a variety of tumor surgeries for its high sensitivity and high negative predictive value. In the evaluation of the status of lymph node metastases in gynecological malignancies, it has received increasingly more attention due to its minor invasiveness, few complications, and high diagnosis rate. The National Comprehensive Cancer Network (NCCN) guidelines provide an excellent introduction to the indications and methods of SLN techniques in vulvar, cervical, and endometrial cancers, but they provide little explanation about some specific issues. In this review, we summarize different dyes and injection methods and discuss the indications of application and the clinical trials of SLN mapping in gynecological malignant tumors, aiming to provide a reference for the rational application of sentinel techniques in gynecology malignant tumors before relevant guidelines are updated.
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Jing H, Xiuhong W, Ying Y, Zhenrong L, Xiyun C, Deping L, Changmei S, Qi W, Tao P, Yiyun P. Neoadjuvant chemotherapy combined with radical surgery for stage IB2/IIA2 cervical squamous cell carcinoma: a prospective, randomized controlled study of 35 patients. World J Surg Oncol 2021; 19:209. [PMID: 34253208 PMCID: PMC8276376 DOI: 10.1186/s12957-021-02318-y] [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: 03/23/2021] [Accepted: 06/25/2021] [Indexed: 11/12/2022] Open
Abstract
Objective This study aimed to evaluate the clinical outcomes for patients with stage IB2/IIA2 cervical squamous cell carcinoma treated with neoadjuvant chemotherapy combined with radical surgery. Methods A total of 68 patients with cervical squamous cell carcinoma were randomly divided into the experimental group (n = 35) and the control group (n = 33). The patients in the experimental group received paclitaxel plus cisplatin neoadjuvant chemotherapy for two cycles, then underwent radical hysterectomy and bilateral adnexectomy at 2 weeks post-chemotherapy. The control group only underwent radical hysterectomy and bilateral adnexectomy after the diagnosis of cervical squamous cell carcinoma. The toxic and side effects of chemotherapy in the experimental group were observed. Also, the operation method, operation time, blood loss, grade of wound healing, complications, and postoperative pathology were noted in the two groups. Primary foci and pelvic lymph node recurrence and distant metastasis were observed, and 3-year and 5-year survival rates were calculated. Results Only one patient in the experiment had grade III bone marrow suppression; no other grade III and IV chemotherapy toxic reactions were observed. The operation was successfully completed in all patients. The operation time, intraoperative blood loss, placement of the ureteral catheter, bladder injury, ureteric injury, postoperative urinary tub, pelvic drainage tube indwelling time, anal exhaust time, postoperative complications, and metastatic ratio of lymph nodes were not significantly different between the two groups (P > 0.05). The number of dissected lymph nodes, deep myometrial invasion, and vascular tumor emboli showed a significant difference in the experimental group compared with the control group (P < 0.05). The 3-year disease-free survival (82.9% vs 81.9%), 5-year disease-free survival (71.4% vs 60.6%), 3-year overall survival (91.4% vs 87.8%), and 5-year overall survival (82.9% vs 75.6%) were not statistically significantly different between the experimental group and the control group (P > 0.05). Conclusions Neoadjuvant chemotherapy in IB2/IIA2 stage cervical squamous cell carcinoma showed low toxic side effects. Radical surgery after chemotherapy is safe and feasible. It plays a coordinating role in reducing the tumor infiltration depth of the deep muscle layer and the incidence of vascular tumor emboli, reducing the use of postoperative adjuvant therapy, and improving the quality of life of patients, but does not improve the 3-year/5-year survival rate.
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Affiliation(s)
- Huang Jing
- Department of Gynecology and Oncology, Ganzhou Cancer Hospital, Ganzhou, 341000, China
| | - Wu Xiuhong
- Radiotherapy Center, Ganzhou Cancer Hospital, Ganzhou, 341000, China
| | - Yu Ying
- Department of Gynecology and Oncology, Ganzhou Cancer Hospital, Ganzhou, 341000, China
| | - Liao Zhenrong
- Department of Gynecology and Oncology, Ganzhou Cancer Hospital, Ganzhou, 341000, China
| | - Cheng Xiyun
- Department of Gynecology and Oncology, Ganzhou Cancer Hospital, Ganzhou, 341000, China
| | - Luo Deping
- Department of Gynecology and Oncology, Ganzhou Cancer Hospital, Ganzhou, 341000, China
| | - Shen Changmei
- Department of Gynecology and Oncology, Ganzhou Cancer Hospital, Ganzhou, 341000, China
| | - Wang Qi
- Department of Gynecology and Oncology, Ganzhou Cancer Hospital, Ganzhou, 341000, China
| | - Peng Tao
- Department of Gynecology and Oncology, Ganzhou Cancer Hospital, Ganzhou, 341000, China
| | - Pan Yiyun
- Department of Chemotherapy Center, Ganzhou Cancer Hospital, No.19, Hua Yuan Qian Road, Ganzhou, 341000, Jiangxi Province, China.
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Tu H, Huang H, Xian B, Li J, Wang P, Zhao W, Chen X, Xie X, Wang C, Kong B, Xiao J, Zhang P, Liu J. Sentinel lymph node biopsy versus pelvic lymphadenectomy in early-stage cervical cancer: a multi-center randomized trial (PHENIX/CSEM 010). Int J Gynecol Cancer 2020; 30:1829-1833. [PMID: 32973117 DOI: 10.1136/ijgc-2020-001857] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND There is no accepted strategy for applying sentinel lymph node (SLN) biopsy as an alternative to pelvic lymphadenectomy in cervical cancer. It is unclear whether and when pelvic lymphadenectomy can be safely replaced by SLN biopsy alone. PRIMARY OBJECTIVE To comprehensively compare the oncological outcomes of SLN biopsy with pelvic lymphadenectomy in patients with and without SLN metastasis. STUDY HYPOTHESIS It is hypothesized that the oncological outcomes provided by SLN biopsy are non-inferior to those of pelvic lymphadenectomy in patients with clinically early-stage cervical cancer if risk-adapted adjuvant treatments are given. TRIAL DESIGN All eligible patients will undergo SLN biopsy at the start of surgery. The resected SLNs will be submitted for frozen section examination. and patients will be triaged into the PHENIX-I (SLN-negative) or PHENIX-II (SLN-positive) cohort. In each cohort of this trial, patients will be randomized in a 1:1 ratio into the experimental (SLN biopsy alone) or reference (pelvic lymphadenectomy) arm. Radical hysterectomy will be performed for all patients, and adjuvant treatments will be planned according to post-operative pathological factors. MAJOR INCLUSION/EXCLUSION CRITERIA Patients aged between 18 and 65 years with histologically confirmed, untreated stage IA1 (lymphovascular space involvement), IA2, IB1, and IB2 cervical squamous carcinoma, adenocarcinoma, or adenosquamous carcinoma. PRIMARY ENDPOINT The primary endpoint is disease-free survival. SAMPLE SIZE Estimated sample sizes of 830 and 250 are required to fulfill the study objectives of PHENIX-I and II, respectively. ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS As of May 2020, more than 600 eligible patients have been enrolled. Enrollment is expected to be completed by December 2022, and presentation of results is expected in 2026. TRIAL REGISTRATION NCT02642471.
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Affiliation(s)
- Hua Tu
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - He Huang
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Bingna Xian
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jibin Li
- Clinical Trial Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ping Wang
- Department of Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Weidong Zhao
- Department of Gynecologic Oncology, Anhui Provincial Cancer Hospital, Hefei, China
| | - Xiaojun Chen
- Department of Gynecologic Oncology, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - Xing Xie
- Department of Gynecologic Oncology, Women's Hospital of Zhejiang University, Hangzhou, China
| | - Chunyan Wang
- Department of Gynecologic Oncology, Liaoning Cancer Hospital, Shenyang, China
| | - Beihua Kong
- Department of Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Jing Xiao
- Department of Gynecology, Guangdong Province Traditional Chinese Medical Hospital, Guangzhou, China
| | - Ping Zhang
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Jihong Liu
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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