Sentinel lymph nodes in early stage cervical cancer

Gynecol Oncol. 2007 May;105(2):285-90. doi: 10.1016/j.ygyno.2007.02.008. Epub 2007 Mar 21.


Objectives: Lymph node status is the most important prognostic factor in cervical cancer. Sentinel lymph node (SLN) procedures have been purported to reduce peri- and postoperative morbidity and operative time.

Methods: All patients with surgically managed clinical FIGO stage IA/B1 cervical cancer underwent SLN followed by pelvic lymphadenectomy with technetium+/-lymphazurin from April 2004 to April 2006. 0.1-0.2 mci of filtered sulfur colloid technetium was injected submucosally into 4 quadrants of the exocervix. Lymphazurin (4cc) was only used if technetium was unsuccessful in identifying bilateral sentinel lymph nodes. Serial microsections at 5 microm intervals were performed and stained intraoperatively. Complete pelvic node dissections were performed in all patients.

Results: Forty-two patients underwent SLN, prior to full pelvic lymphadenectomy. Thirty-nine patients were included for the purposes of this study. The incidence in detecting at least one sentinel node was 98% per patient, and 85% per side. Identification of bilateral sentinel lymph nodes was successful in 28 cases (72%). The median number of SLN/side was 2. Three patients were found to have metastatic tumor to lymph nodes. No false negatives were identified. No adverse effects were noted.

Conclusions: SLN biopsy in cervical cancer is feasible to do, with a low false negative rate. We believe SLN should be evaluated per side and not per patient, that a pelvic lymphadenectomy is otherwise required. By following this protocol, the false negative rate can be minimized. The combined reported FN rate in the literature is 1.8%. If our definition is applied, the majority of reported false negative SLN is not actual false negatives.

MeSH terms

  • Adult
  • Aged
  • Female
  • Humans
  • Hysterectomy
  • Lymph Node Excision
  • Lymph Nodes / diagnostic imaging
  • Lymph Nodes / pathology*
  • Lymph Nodes / surgery
  • Middle Aged
  • Neoplasm Staging
  • Radionuclide Imaging
  • Radiopharmaceuticals
  • Rosaniline Dyes
  • Sentinel Lymph Node Biopsy / methods*
  • Technetium
  • Technetium Tc 99m Sulfur Colloid
  • Uterine Cervical Neoplasms / diagnostic imaging
  • Uterine Cervical Neoplasms / pathology*
  • Uterine Cervical Neoplasms / surgery


  • Radiopharmaceuticals
  • Rosaniline Dyes
  • iso-sulfan blue
  • Technetium Tc 99m Sulfur Colloid
  • Technetium