Objectives. The aim of this study was to investigate the feasibility of sentin el lymph node (SLN) identification using radioisotopic lymphatic mapping with te chnetium-99 m-labeled phytate in patients undergoing radical hysterectomy with pelvic lymphadenectomy for treatment of early cervical cancer. Methods. Between July 2001 and February 2003, 56 patients with cervical cancer FIGO stage I (n = 53) or stage II (n = 3)underwent sentinel lymph node detection with preoperativ e lymphoscintigraphy (99mTc-labeled phytate injected into the uterine cervix, a t 3, 6, 9, and 12 o’clock, at a dose of 55-74 MBq in a volume of 0.8 ml) and i ntraoperative lymphatic mapping with a handheld gamma probe. Radical hysterectom y was aborted in three cases because parametrial invasion was found intraoperati vely and we performed only sentinel node resection. The remaining 53 patients un derwent radical hysterectomy with complete pelvic lymphadenectomy. Sentinel node s were detected using a handheld gamma-probe and removed for pathological asses sment during the abdominal radical hysterectomy and pelvic lymphadenectomy. Resu lts. One or more sentinel nodes were detected in 52 out of 56 eligible patients (92.8%). A total of 120 SLNs were detected by lymphoscintigraphy (mean 2.27 nod es per patient) and intraoperatively by gamma probe. Forty-four percent of SLNs were found in the external iliac area, 39%in the obturator region, 8.3%in int eriliac region, and 6.7%in the common iliac area. Unilateral sentinel nodes wer e found in thirty-one patients (59%). The remaining 21 patients (41%) had bil ateral sentinel nodes. Microscopic nodal metastases were confirmed in 17 (32%) cases. In 10 of these patients, only SLNs had metastases. The 98 sentinel nodes that were negative on hematoxylin and eosin were submitted to cytokeratin immuno histochemical analysis. Five (5.1%) micrometastases were identified with this t echnique. The sensitivity of the sentinel node was 82.3%(CI 95%56.6-96.2) and the negative predictive value was 92.1%(CI 95%78.6-98.3). The accuracy of se ntinel node in predicting the lymph node status was 94.2%. Conclusion. Preopera tive lymphoscintigraphy and intraoperative lymphatic mapping with 99mTc-labeled phytate are effective in identifying sentinel nodes in patients undergoing radi cal hysterectomy and to select women in whom lymph node dissection can be avoide d.
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