The utilized SLN algorithm is equivalent to a full PLND to detect pelvic nodal metastases in early-stage cervical cancer.

The proximal obturator fossa is the predominate position for metastatic SLNs in cervical cancer.

The Parauterine Lymphovascular Tissue should be removed and assessed as SLN-tissue.

All pelvic node positive patients were identified through the ICG-based SLN algorithm.

A single center prospective non-randomized study to assess a systematically developed anatomically-based sentinel lymph node (SLN) algorithm in cervical cancer.

Consecutive women with FIGO 2009 stage 1A2-2A1 cervical cancer undergoing robotic radical hysterectomy/trachelectomy between September 2014 and January 2023 had cervically injected Indocyanine Green (ICG) as a tracer for detection of pelvic SLN. An anatomically based surgical algorithm was adhered to; defining SLNs as the juxtauterine mapped nodes within the upper and lower paracervical lymphatic pathways including separate removal of the parauterine lymphovascular tissue (PULT). A completion pelvic lymphadenectomy was performed. Ultrastaging and immunohistochemistry was performed on SLNs, including the PULT.

181 women were included for analysis. Median histologic tumor size was 14.0 mm (range 2–80 mm). The bilateral mapping rate was 98.3%. As per protocol an interim analysis rejected H0 and inclusion stopped at 29 node positive women, all identified by at least one metastatic ICG-defined SLN. One woman awaiting histology at study-closure was node positive and included in the analysis. Sensitivity was 100% (95% CI, 88.4%–100%) and NPV 100% (95% CI, 97.6%–100%). In node positive women, the proximal obturator position harbored 46.1% of all SLN metastases representing the only position in 40% and 10% had isolated metastases in the PULT.

Strictly adhering to an anatomically based SLN-algorithm including identification of parallell lymphatics within major pathways, partilularly the obturator compartment, assessment of the PULT, restricting nodal dissection to the removal of SLNs accurately identifies pelvic nodal metastatic disease in early-stage cervical cancer.

Sentinel lymph node

SLN-algorithm

Proximal obturator fossa

Cervical cancer

© 2024 The Author(s). Published by Elsevier Inc.