Clinical Study Of Sentinel Lymph Nodes Detection Guided Radical Abdominal Trachelectomy For Early Stage Cervical Cancer

Objective: To evaluate the clinical significance of sentinel lymph nodes(SLN)test to predict lymph node metastasis in patients with early cervical cancer and to guide radical abdominal trachelectomy(RAT).Methods: A total of 118 cases of FIGO 1A1-1B1 cervical cancer patients that underwent fertility-preserving surgical treatment in the affiliated Shandong Cancer Hospital of Shandong University were included in this study.The patients received radionuclide 99mTc-sulfur colloid injection under cervical mucosa before surgery.During the surgery,SLN were identified,resected,and send for rapid pathological examination to exclude lymph node metastasis,then RAT and pelvic lymph node dissection were performed.After surgery,the SLN and other pelvic lymph nodes were send for conventional pathological examination and anti-keratin immunohistochemical staining.SLN pathological examination results,intraoperative blood loss,operation time,intraoperative and postoperative complications,recurrence rate,and conception rate were observed to evaluate the clinical significance of SLN test to guide RAT surgery for patients with early cervical cancer.Result:(1)A total of 414 SLNs were detected in 114 of the patients,that is 3.6 SLNs per patient and 96.7% of all patients.Wherein,91.2% had SLNs on both sides,and 8.8% had SLNs only on one side.Presence of SLN showed no significant correlation with patient age,FIGO staging,tumor differentiation level,or tumor size(p = 0.722,0.944,0.859,and 0.629,respectively).Twelve of the patients showed SLN metastasis in rapid pathological examination and received extensive hysterectomy,and the other received RAT.(2)Postoperative pathological examination showed a rate of pelvic lymph node metastasis of 11.1%.The sensitivity of rapid SLN pathological examination to predict pelvic lymph node metastasis was 92.3%,specificity 100%,positive predictive value 100%,negative predictive value 99%,false negative rate 7.7%,and coincidence rate 99.1%.None of the 104 cases that showed negative results in the intraoperative rapid SLN examination showed lymph node metastasis in the postoperative pathological examination.(3)RAT was successfully performed for 106 of these patients,with a median operation time of 240 min,median blood loss 400 ml.RAT was successfully performed for 106 of these patients,with a median operation time of 240 min,median blood loss 400 ml.Intraoperative complications included uterine artery injury,bladder muscle damage,while postoperative complications included residual cervical canal stenosis(18.9%),non-infectious pelvic lymph nodes(10.2%),leg edema(5.9%),and menopause(2.8%).(4)103 of the 106 patients that received RAT completed the follow-up,with a median follow-up time of 90 months.Median tumor-free survival time was 97 months,recurrence rate was 3.8%,mortality rate was 1.9%,and conception rate was 30.2%,wherein,7 cases had lived delivery,8 had spontaneous abortion(3 at 3 months of pregnancy,1 at 6 months,and 2 at 7 months),2 patients are currently in pregnancy.Conclusions: SLN examination after injection of radioactive nuclide 99mTc-sulfur colloid can accurately predict pelvic lymph node metastasis in patients with early cervical cancer.It is safe and feasible for patients with early cervical cancer to receive RAT that maintains fertility if SLN test results are negative.This method shall be promoted for wider clinical application.