SENTINEL LYMPH NODE BIOPSY IN EARLY STAGE OF CERVICAL CANCER . DUAL INJECTION TECHNIQUE.

Objectives: To perform and evaluate the diagnostic accuracy of sentinel node dissection in early stage of cervical cancer using dual injection technique.

Methods: a prospective study has been performed between May 2013 and May 2018, involving 19 patients with early stage of cervical carcinoma ( IA2, IB1, IIA). Previous to surgery, a injection of 74-111MBq de 99^mTc-nanocoloide were done in a subepithelial cervix area. A lymphoscintigraphy was subsequently performed to give preoperative guidance. The blue dye is injected to the cervix in the surgery room with the same technique as the radiotracer was injected. All patients underwent laparoscopic surgical cancer resection, sentinel lymph node study and pelvic lymphadenectomy. Intraoperatively sentinel nodes were detected by gamma prove (if they were radioactive) and/or visualized (if they were stained). All nodes obtained were analyzed histopathologically.

Results: Intraoperatively sentinel node detection only by radiative technique was 89.5% (17/19) and 93.7% (18/19) through dual technique. Only 2 patients didn’t show migration by lymphoscintigraphy and sentinel node was not detected by gamma prove. One of them was detected by blue stain. When the final pathology of sentinel node was negative, the rest of nodes found in pelvic lymphadenectomy were negative as well (No false negative cases). In 3 patients (15.8%), sentinel node was the only metastatic node, being the rest of lymphadenectomy negative. After 6 months of follow no a lymph node recurrence were found.

Conclusions: Sentinel lymph node detection give reliable information of lymphatic of nodal status in early stage of cervical cancer. Dual injection technique increase the detection capacity. It could allow to minimize surgical morbidity avoiding unnecessary pelvic lymphadenectomies.