Anne-Sophie Bats1, Albane Frati2, Patrice Mathevet3, Isabelle Orliaguet4, Denis Querleu5, Slimane Zerdoud6, Eric Leblanc7, Hélène Gauthier8, Catherine Uzan9, Désirée Deandreis10, Emile Darai11, Khaldoun Kerrou12, Henri Marret13, Emilie Lenain14, Marc Froissart15, Fabrice Lecuru16. 1. Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Chirurgie Cancérologique Gynécologique et du Sein, Paris, France; INSERM UMR-S 747, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. Electronic address: anne-sophie.bats@egp.aphp.fr. 2. Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Chirurgie Cancérologique Gynécologique et du Sein, Paris, France. 3. Hôpital Femme-Mère-Enfant, Chirurgie Gynécologique, Bron, France; Université Lyon I, Lyon, France. 4. Hôpital Edouard Herriot, Médecine Nucléaire, Lyon, France. 5. Institut Claudius Regaud, Chirurgie Générale, Toulouse, France. 6. Institut Claudius Regaud, Médecine Nucléaire, Toulouse, France. 7. Center Oscar Lambret, Chirurgie Générale, Lille, France. 8. Center Oscar Lambret, Médecine Nucléaire, Lille, France. 9. Institut Gustave Roussy, Chirurgie Générale, Villejuif, France. 10. Institut Gustave Roussy, Médecine Nucléaire, Villejuif, France. 11. Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Gynécologie-Obstétrique, Paris, France. 12. Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Médecine Nucléaire, Paris, France. 13. Hôpital Bretonneau, CHRU de Tours, Gynécologie-Obstétrique, Tours, France. 14. Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Département d'Informatique Hospitalière, Evaluation et Gestion des Connaissances, Paris, France. 15. Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Médecine Nucléaire, Paris, France. 16. Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Chirurgie Cancérologique Gynécologique et du Sein, Paris, France; INSERM UMR-S 747, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
Abstract
PURPOSE: To evaluate the contribution of preoperative lymphoscintigraphy to intraoperative lymphatic mapping (ILM) in early cervical cancer METHODS: We conducted an ancillary analysis of the multicenter prospective SENTICOL study in early cervical cancer. Radiocolloid was injected intracervically on the day before (long protocol) or morning of (short protocol) surgery, lymphoscintigraphy was performed, and the results of a centralized image review were communicated to the surgeons. ILM was performed on combined radioactivity/patent blue detection. Sentinel lymph nodes (SLNs) were electively sampled before routine bilateral pelvic lymphadenectomy by laparoscopy. RESULTS: Of 139 patients in the modified intention-to-diagnose analysis, 114 had centrally reviewed lymphoscintigrams, which showed 352 SLNs in 100 patients. Lymphoscintigraphy and ILM detection rates were 87.8% and 97.8%, respectively. Agreement between lymphoscintigraphy and ILM was low for the number of SLNs (κ=0.23; -0.04; 0.49) and bilateral SLNs (κ=0.36; 0.2; 0.52). No patient without SLNs by ILM had SLNs by lymphoscintigraphy. Lymphoscintigraphy identified substantial proportions of unusual drainage pathways. No patients with metastatic nodes had SLNs by lymphoscintigraphy but not by ILM in the relevant territory. In 1 of the 2 patients with false-negative SLN results, SLNs were bilateral by lymphoscintigraphy and unilateral by ILM. CONCLUSION: Although the detection rate was lower by lymphoscintigraphy than by ILM, the substantial proportions of SLNs in unusual territories provided valuable guidance for the surgical exploration. Awareness of the limited agreement between lymphoscintigraphic and surgical detection might help surgeons decrease the false-negative rate.
PURPOSE: To evaluate the contribution of preoperative lymphoscintigraphy to intraoperative lymphatic mapping (ILM) in early cervical cancer METHODS: We conducted an ancillary analysis of the multicenter prospective SENTICOL study in early cervical cancer. Radiocolloid was injected intracervically on the day before (long protocol) or morning of (short protocol) surgery, lymphoscintigraphy was performed, and the results of a centralized image review were communicated to the surgeons. ILM was performed on combined radioactivity/patent blue detection. Sentinel lymph nodes (SLNs) were electively sampled before routine bilateral pelvic lymphadenectomy by laparoscopy. RESULTS: Of 139 patients in the modified intention-to-diagnose analysis, 114 had centrally reviewed lymphoscintigrams, which showed 352 SLNs in 100 patients. Lymphoscintigraphy and ILM detection rates were 87.8% and 97.8%, respectively. Agreement between lymphoscintigraphy and ILM was low for the number of SLNs (κ=0.23; -0.04; 0.49) and bilateral SLNs (κ=0.36; 0.2; 0.52). No patient without SLNs by ILM had SLNs by lymphoscintigraphy. Lymphoscintigraphy identified substantial proportions of unusual drainage pathways. No patients with metastatic nodes had SLNs by lymphoscintigraphy but not by ILM in the relevant territory. In 1 of the 2 patients with false-negative SLN results, SLNs were bilateral by lymphoscintigraphy and unilateral by ILM. CONCLUSION: Although the detection rate was lower by lymphoscintigraphy than by ILM, the substantial proportions of SLNs in unusual territories provided valuable guidance for the surgical exploration. Awareness of the limited agreement between lymphoscintigraphic and surgical detection might help surgeons decrease the false-negative rate.
Authors: Yan Yan Yu; Rui Zhang; Rui Tong Dong; Qi Yun Hu; Tao Yu; Fan Liu; Ya Hong Luo; Yue Dong Journal: Br J Radiol Date: 2019-04-01 Impact factor: 3.039