Dual Agents Make Sentinel Node Identification Reliable in Cervical Cancer Patients
NEW YORK (Reuters Health) Feb 25
In patients with cervical cancer, the use of both radiocolloid and blue dye improves lymphatic mapping and results in a sentinel node identification rate of 100%, according to researchers at The University of Texas.
Dr. Charles Levenback, of M. D. Anderson Cancer Center in Houston, and colleagues enrolled 39 such patients in a prospective study of the combined technique. The patients were scheduled for surgical exploration with the intent of undergoing radical hysterectomy and total pelvic lymphadenectomy.
Prior to surgery all patients underwent lymphoscintigraphy with injection of technicium-99 radiocolloid into the cervix, and blue dye was injected during surgery. Lymphoscintigraphy localized at least one sentinel node preoperatively in 33 of the 39 patients, Dr. Levenback's group reports in the Journal of Clinical Oncology for February 1. Sentinel nodes in the other six patients were identified intraoperatively.
Of the 132 sentinel nodes identified at surgery, 49% were both blue and radioactive, 26% were identified by blue dye only, and 24% were identified by radioactivity only.
Altogether, 996 lymph nodes were removed from the patients. Metastatic disease was found in eight patients, including one patient who had false-negative sentinel nodes.
The Texas team calculated the sensitivity of the sentinel node to be 87.5% and the negative predictive value to be 97%.
Other researchers have argued that the concept of sentinel nodes does not apply to cervical cancer, Dr. Levenback and his associates note. "Like these authors, we too found positive lymph nodes throughout the pelvis and para-aortic regions.
However, the fact that we could select these positive nodes with our mapping techniques indicates to us that the sentinel node concept most likely applies to the cervix."
Still, "these data are not sufficient to recommend abandoning standard practice," the researchers caution. They recommend proceeding with a multi-institutional trial.
J Clin Oncol 2002;20:688-693.
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