Objective: To investigate the application of sentinel lymph node biopsy (SLNB) in early-staged
cervical cancer by laparoscopy. Methods: It was a prospective, single-arm, single-center clinical study. Seventy-eight cases of
cervical cancer patients were collected from July 2015 to December 2018 at the Fourth Hospital of Hebei Medical University. All the patients were injected with tracer into the disease-free block of cervical tissue after
anesthesia by the same surgeon who learned sentinel lymph node (SLN) mapping technique in Memorial Sloan-Kettering
Cancer Center, and underwent SLN mapping followed by complete pelvic
lymphadenectomy. Moreover, all the dissected lymph nodes were stained with
hematoxylin eosin staining (HE) pathological examination. Besides, the negative SLN on
hematoxylin-
eosin staining were detected by immunohistochemistry
cytokeratin staining micro-
metastasis. To analyze the distribution, detection rate, false negative rate the sensitivity and negative predictive value of the SLN in early-staged
cervical cancer by laparoscopy, and explore the value of SLN mapping in predicting the lymph nodes
metastasis in early-staged
cervical cancer. Results: The overall detection rate of SLN in
cervical cancer was 99% (77/78), bilateral detection rate was 87% (68/78). The average of 12.4 lymph node (LN) and 3.6 SLN were dissected for each patients each side. SLN of
cervical cancer were mainly distributed in the obturator space (61.5%, 343/558), followed by external iliac (23.5%, 131/558), common iliac (7.3%, 41/558), para-uterine (3.8%, 21/558), internal iliac (2.2%, 12/558), para abdominal aorta (1.1%, 6/558), and anterior sacral lymphatic drainage area (0.7%, 4/558). Fourteen cases of LN
metastasis were found among all 78 cases. There were a total of 38 positive LN, including 26 SLN
metastasis and 12 none sentinel LN
metastasis. Through immunohistochemical staining and pathological ultra-staging, 1 SLN was found to be isolated
tumor cells (ITC), and 5 SLNs were found to be micro-
metastases (MIC), accounting for 23% (6/26) of positive SLN. SLN mapping with pathological ultra-staging improved the prediction of LN
metastasis in
cervical cancer (2/14). Metastatic SLN mainly distributed in the obturator space (65%, 17/26), peri-uterine region (12%, 3/26), common iliac region (15%, 4/26), and external iliac region (8%, 2/26). The consistency of the diagnosis of
lymph node metastasis by SLN biopsy and postoperative retroperitoneal
lymph node metastasis showed that the Kappa value was 1.000 (P<0.001), indicated that the
metastasis status of SLN and retroperitoneal lymph node were completely consistent. The sensitivity, specificity, accuracy, false-negative rate, and negative predictive value of SLN biopsy in the diagnosis of
lymph node metastasis were 100%, 100%, 100%, 0, and 100%, respectively. Conclusions: SLN in early-staged
cervical cancer patients were mainly distributed in the obturator and external iliac space, pathalogical ultra-staging of SLN could improve the prediction of LN
metastasis. Intraoperative SLN mapping is safe, feasible and could predict the state of retroperitoneal LN
metastasis in early-staged
cervical cancer. SLNB may replace systemic pelvic
lymphadenectomy.