The majority of women with cervical cancer can safely undergo sentinel node biopsy instead of full pelvic lymph node dissection to determine the spread of their disease, thereby avoiding the complications associated with the more invasive procedure, according to the results of a study presented at the 2009 annual meeting of the American Society of Clinical Oncology in Orlando, Florida.
Cervical cancer affects the cervix, the part of the body that connects the uterus (womb) to the vagina (birth canal). Women who receive treatment for early-stage cervical cancer generally have an excellent prognosis, with a cure rate of greater than 90%. However, once cervical cancer has spread away from the cervix to distant areas in the body, it becomes more difficult to treat and cure.
In order to evaluate whether cervical cancer has spread, surgeons typically perform a pelvic lymph node dissection (removal of lymph nodes). A traditional pelvic lymph node dissection is an invasive procedure and often results in complications such as lymphedema, a buildup of lymph fluid that results in swelling and pain.
Sentinel lymph node biopsy is a less-invasive technique during which only one to three nodes, called the sentinel nodes, are removed. The sentinel node is the first node that drains a particular area, such as the pelvis. In a sentinel node biopsy, the surgeon injects a dye into the affected area to identify which node is the first to be marked by the dye and then removes that node. If the sentinel lymph node is free of cancer, then it is unlikely any of the other lymph nodes located “downstream” have cancer and they are not removed. If, however, the sentinel node does contain cancer, surgeons will proceed with a full pelvic lymph node dissection.
Researchers in France conducted a study to evaluate sentinel lymph node biopsy in women with early-stage cervical cancer. The study involved 128 women with early-stage (Stage IA-1B) cervical cancer who underwent sentinel node biopsy followed by routine pelvic lymph node dissection. The surgeons detected sentinel nodes in 98.4% of patients and found a total of 430 sentinel nodes. There were a total of 26 positive sentinel nodes (containing cancer) in 21 patients. The surgeons found no node metastases in 104 patients, leading them to conclude that full pelvic lymph node dissection could have been avoided in approximately 80% of patients.
The researchers concluded that sentinel lymph node biopsy is a safe, effective alternative to full pelvic lymph node dissection and may allow the majority of women to potentially avoid complications, such as lymphedema, that are associated with the more invasive procedure.
 Lecuru F, Bats A Mathevet P, et al. Impact of sentinel lymph node biopsy on staging of early cervical cancer. Results of a prospective, multicenter study. Presented at the 2009 annual meeting of the American Society of Clinical Oncology, May 29-June 2, 2009, Orlando, FL. Abstract CRA5506.