Sentinel lymph node detection in early stage uterine cervix carcinoma: A systematic review

Sentinel node detection in patients with thyroid carcinoma: a meta-analysis

Objective

This study was designed to review the diagnostic performance of sentinel node (SN) detection for assessment of the nodal status in thyroid carcinoma patients and to determine the technique (using blue dye or Technetium-99m colloid (^99mTc)) that demonstrated the highest success rate with regard to the detection rate and sensitivity.

Methods

A comprehensive computer literature search of studies published in English language through December 2007 and regarding SN procedures in patients with thyroid disorders was performed in MEDLINE. Pooled values regarding the SN detection rate and the pooled sensitivity values of the SN procedure were presented with a 95% confidence interval (CI) for the different SN detection techniques.

Results

Ultimately, we identified 14 studies comprising a total of 457 patients. Of these, ten studies (n = 329 patients) used the blue dye technique with a pooled SN detection of 83% (95% CI, 79–87%). The remaining four studies (n = 128) used ^99mTc-colloid with a pooled SN detection of 96% (95% CI, 91–99%; p < 0.05 vs. blue dye technique).

Conclusion

In patients with suspected thyroid carcinoma, SN biopsy demonstrated a higher SN detection rate when ^99mTc was used (96%) instead of the blue dye technique (83%).

Changes in pulse oximetry after patent blue dye injection into the uterine cervix

BACKGROUND

To evaluate changes in pulse oximetry readings in patients with cervical carcinoma after the injection of patent blue dye into the uterine cervix for sentinel lymph node detection.

METHODS

Fifty-six patients underwent radical hysterectomy and bilateral pelvic lymphadenectomy for the treatment of International Federation of Gynecology and Obstetrics stage I or II cervical cancer. Four milliliters of patent blue dye were injected into the cervix. On the eve of surgery, all patients also received an injection of Dextran 500 labeled with technetium 99 m (Tc-99 m Dextran, 600 to 800 muCi) into the cervix and subsequently underwent pelvic lymphoscintigraphy.

RESULTS

Of the 56 patients, 1 (1.79%) had an anaphylactic reaction, and in 13 (23.22%), pulse oximetry readings were <96%. The lowest median pulse oximetry reading in these patients was 87%. Pulse oximetry readings began to decrease between 2 and 10 minutes after patent blue dye injection into the cervix and lasted for approximately 5 minutes. No changes in blood pressure, heart rate, or electrocardiogram were found during the period in which this alteration was recorded by the pulse oximeter.

CONCLUSION

The decrease in pulse oximetry readings after patent blue dye injection into the cervix was associated with larger tumors and tumors that surrounded the external cervical os.

Advances in Surgical Treatment of Cervical Cancer

Radical hysterectomy has been the standard surgical treatment for cervical cancer, achieving a good survival outcome. However, it is a major operation that has considerable potential long-term morbidity. With good prognosis achieved in most early cervical cancers, there is a trend towards more emphasis on maintaining good quality of life post-treatment. Many women diagnosed with cervical cancer are young, and fertility-sparing surgery such as trachelectomy would preserve their reproductive potential. Minimally invasive surgery, such as laparoscopic radical hysterectomy, can potentially improve post-operative recovery and cosmetic results while maintaining oncological safety. Sentinel lymph nodes assessment can minimize unnecessary systematic pelvic lymphadenectomy. Radicality of the hysterectomy may also be reduced in selected individuals with good prognostic factors, thus minimizing long-term pelvic floor dysfunction. This review aims to give a broad overview of the current status of these new trends in surgical management for cervical cancer.