Links to Exploration step
Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The detection of sentinel lymph nodes in laparoscopic surgery for uterine cervical cancer using 99m-technetium-tin colloid, indocyanine green, and blue dye</title><author><name sortKey="Tanaka, Tomohito" sort="Tanaka, Tomohito" uniqKey="Tanaka T" first="Tomohito" last="Tanaka">Tomohito Tanaka</name><affiliation><nlm:aff id="A1">Department of Obstetrics and Gynecology, Osaka Medical College, Osaka,<country>Japan</country>.</nlm:aff></affiliation></author><author><name sortKey="Terai, Yoshito" sort="Terai, Yoshito" uniqKey="Terai Y" first="Yoshito" last="Terai">Yoshito Terai</name><affiliation><nlm:aff id="A1">Department of Obstetrics and Gynecology, Osaka Medical College, Osaka,<country>Japan</country>.</nlm:aff></affiliation></author><author><name sortKey="Ashihara, Keisuke" sort="Ashihara, Keisuke" uniqKey="Ashihara K" first="Keisuke" last="Ashihara">Keisuke Ashihara</name><affiliation><nlm:aff id="A1">Department of Obstetrics and Gynecology, Osaka Medical College, Osaka,<country>Japan</country>.</nlm:aff></affiliation></author><author><name sortKey="Tsunetoh, Satoshi" sort="Tsunetoh, Satoshi" uniqKey="Tsunetoh S" first="Satoshi" last="Tsunetoh">Satoshi Tsunetoh</name><affiliation><nlm:aff id="A1">Department of Obstetrics and Gynecology, Osaka Medical College, Osaka,<country>Japan</country>.</nlm:aff></affiliation></author><author><name sortKey="Akagi, Hiroyuki" sort="Akagi, Hiroyuki" uniqKey="Akagi H" first="Hiroyuki" last="Akagi">Hiroyuki Akagi</name><affiliation><nlm:aff id="A2">Department of Radiology, Osaka Medical College, Osaka,<country>Japan</country>.</nlm:aff></affiliation></author><author><name sortKey="Yamada, Takashi" sort="Yamada, Takashi" uniqKey="Yamada T" first="Takashi" last="Yamada">Takashi Yamada</name><affiliation><nlm:aff id="A3">Department of Pathology, Osaka Medical College, Osaka,<country>Japan</country>.</nlm:aff></affiliation></author><author><name sortKey="Ohmichi, Masahide" sort="Ohmichi, Masahide" uniqKey="Ohmichi M" first="Masahide" last="Ohmichi">Masahide Ohmichi</name><affiliation><nlm:aff id="A1">Department of Obstetrics and Gynecology, Osaka Medical College, Osaka,<country>Japan</country>.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27894166</idno><idno type="pmc">5323283</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5323283</idno><idno type="RBID">PMC:5323283</idno><idno type="doi">10.3802/jgo.2017.28.e13</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">004074</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">004074</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The detection of sentinel lymph nodes in laparoscopic surgery for uterine cervical cancer using 99m-technetium-tin colloid, indocyanine green, and blue dye</title><author><name sortKey="Tanaka, Tomohito" sort="Tanaka, Tomohito" uniqKey="Tanaka T" first="Tomohito" last="Tanaka">Tomohito Tanaka</name><affiliation><nlm:aff id="A1">Department of Obstetrics and Gynecology, Osaka Medical College, Osaka,<country>Japan</country>.</nlm:aff></affiliation></author><author><name sortKey="Terai, Yoshito" sort="Terai, Yoshito" uniqKey="Terai Y" first="Yoshito" last="Terai">Yoshito Terai</name><affiliation><nlm:aff id="A1">Department of Obstetrics and Gynecology, Osaka Medical College, Osaka,<country>Japan</country>.</nlm:aff></affiliation></author><author><name sortKey="Ashihara, Keisuke" sort="Ashihara, Keisuke" uniqKey="Ashihara K" first="Keisuke" last="Ashihara">Keisuke Ashihara</name><affiliation><nlm:aff id="A1">Department of Obstetrics and Gynecology, Osaka Medical College, Osaka,<country>Japan</country>.</nlm:aff></affiliation></author><author><name sortKey="Tsunetoh, Satoshi" sort="Tsunetoh, Satoshi" uniqKey="Tsunetoh S" first="Satoshi" last="Tsunetoh">Satoshi Tsunetoh</name><affiliation><nlm:aff id="A1">Department of Obstetrics and Gynecology, Osaka Medical College, Osaka,<country>Japan</country>.</nlm:aff></affiliation></author><author><name sortKey="Akagi, Hiroyuki" sort="Akagi, Hiroyuki" uniqKey="Akagi H" first="Hiroyuki" last="Akagi">Hiroyuki Akagi</name><affiliation><nlm:aff id="A2">Department of Radiology, Osaka Medical College, Osaka,<country>Japan</country>.</nlm:aff></affiliation></author><author><name sortKey="Yamada, Takashi" sort="Yamada, Takashi" uniqKey="Yamada T" first="Takashi" last="Yamada">Takashi Yamada</name><affiliation><nlm:aff id="A3">Department of Pathology, Osaka Medical College, Osaka,<country>Japan</country>.</nlm:aff></affiliation></author><author><name sortKey="Ohmichi, Masahide" sort="Ohmichi, Masahide" uniqKey="Ohmichi M" first="Masahide" last="Ohmichi">Masahide Ohmichi</name><affiliation><nlm:aff id="A1">Department of Obstetrics and Gynecology, Osaka Medical College, Osaka,<country>Japan</country>.</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Gynecologic Oncology</title><idno type="ISSN">2005-0380</idno><idno type="eISSN">2005-0399</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objective</title><p>Our objective was to determine the feasibility and detection rates and clarify the most effective combination of injected tracer types for sentinel lymph node (SLN) mapping in uterine cervical cancer in patients who have undergone laparoscopic surgery or neoadjuvant chemotherapy (NAC).</p></sec><sec><title>Methods</title><p>A total of 119 patients with cervical cancer underwent SLN biopsy at radical hysterectomy using three types of tracers. The various factors related to side-specific detection rate, sensitivity, and false negative (FN) rate were analyzed.</p></sec><sec><title>Results</title><p>The SLN detection rates using 99m-technetium (<sup>99m</sup>Tc)-tin colloid, indigo carmine, and indocyanine green (ICG) were 85.8%, 20.2%, and 61.6%, respectively. The patients with ≥2-cm-diameter tumors and those who received NAC had lower detection rates than those with <2-cm-diameter tumors (75.7% vs. 91.5%, p<0.01) and those who did not receive NAC (67.9% vs. 86.3%, p<0.01), respectively. Laparoscopic procedures had a higher detection rate than laparotomy (100.0% vs. 77.1%, p<0.01). No factors significantly affected the sensitivity; however, the patients with ≥2-cm-diameter tumors (86.0% vs. 1.4%, p<0.01), NAC (19.4% vs. 2.2%, p<0.01), and those who underwent laparotomy (7.4% vs. 0%, p<0.01) had an unfavorable FN rate.</p></sec><sec><title>Conclusion</title><p>Among the examined tracers, <sup>99m</sup>Tc had the highest detection of SLN mapping in patients with uterine cervical cancer. Patients with local advanced cervical cancer with/without NAC treatment might be unsuited for SLN mapping. SLN mapping is feasible and results in an excellent detection rate in patients with <2-cm-diameter cervical cancer. Laparoscopic surgery is the best procedure for SLN detection in patients with early-stage disease.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Pecorelli, S" uniqKey="Pecorelli S">S Pecorelli</name></author><author><name sortKey="Zigliani, L" uniqKey="Zigliani L">L Zigliani</name></author><author><name sortKey="Odicino, F" uniqKey="Odicino F">F Odicino</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Delgado, G" uniqKey="Delgado G">G Delgado</name></author><author><name sortKey="Bundy, B" uniqKey="Bundy B">B Bundy</name></author><author><name sortKey="Zaino, R" uniqKey="Zaino R">R Zaino</name></author><author><name sortKey="Sevin, Bu" uniqKey="Sevin B">BU Sevin</name></author><author><name sortKey="Creasman, Wt" uniqKey="Creasman W">WT Creasman</name></author><author><name sortKey="Major, F" uniqKey="Major F">F Major</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yuan, C" uniqKey="Yuan C">C Yuan</name></author><author><name sortKey="Wang, P" uniqKey="Wang P">P Wang</name></author><author><name sortKey="Lai, C" uniqKey="Lai C">C Lai</name></author><author><name sortKey="Tsu, E" uniqKey="Tsu E">E Tsu</name></author><author><name sortKey="Yen, M" uniqKey="Yen M">M Yen</name></author><author><name sortKey="Ng, H" uniqKey="Ng H">H Ng</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Biewenga, P" uniqKey="Biewenga P">P Biewenga</name></author><author><name sortKey="Van Der Velden, J" uniqKey="Van Der Velden J">J van der Velden</name></author><author><name sortKey="Mol, Bw" uniqKey="Mol B">BW Mol</name></author><author><name sortKey="Stalpers, Lj" uniqKey="Stalpers L">LJ Stalpers</name></author><author><name sortKey="Schilthuis, Ms" uniqKey="Schilthuis M">MS Schilthuis</name></author><author><name sortKey="Van Der Steeg, Jw" uniqKey="Van Der Steeg J">JW van der Steeg</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kim, Si" uniqKey="Kim S">SI Kim</name></author><author><name sortKey="Lim, Mc" uniqKey="Lim M">MC Lim</name></author><author><name sortKey="Lee, Js" uniqKey="Lee J">JS Lee</name></author><author><name sortKey="Lee, Y" uniqKey="Lee Y">Y Lee</name></author><author><name sortKey="Park, K" uniqKey="Park K">K Park</name></author><author><name sortKey="Joo, J" uniqKey="Joo J">J Joo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tanaka, T" uniqKey="Tanaka T">T Tanaka</name></author><author><name sortKey="Terai, Y" uniqKey="Terai Y">Y Terai</name></author><author><name sortKey="Ono, Yj" uniqKey="Ono Y">YJ Ono</name></author><author><name sortKey="Fujiwara, S" uniqKey="Fujiwara S">S Fujiwara</name></author><author><name sortKey="Tanaka, Y" uniqKey="Tanaka Y">Y Tanaka</name></author><author><name sortKey="Sasaki, H" uniqKey="Sasaki H">H Sasaki</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Abu Rustum, Nr" uniqKey="Abu Rustum N">NR Abu-Rustum</name></author><author><name sortKey="Alektiar, K" uniqKey="Alektiar K">K Alektiar</name></author><author><name sortKey="Iasonos, A" uniqKey="Iasonos A">A Iasonos</name></author><author><name sortKey="Lev, G" uniqKey="Lev G">G Lev</name></author><author><name sortKey="Sonoda, Y" uniqKey="Sonoda Y">Y Sonoda</name></author><author><name sortKey="Aghajanian, C" uniqKey="Aghajanian C">C Aghajanian</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Homesley, Hd" uniqKey="Homesley H">HD Homesley</name></author><author><name sortKey="Kadar, N" uniqKey="Kadar N">N Kadar</name></author><author><name sortKey="Barrett, Rj" uniqKey="Barrett R">RJ Barrett</name></author><author><name sortKey="Lentz, Ss" uniqKey="Lentz S">SS Lentz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Morton, Dl" uniqKey="Morton D">DL Morton</name></author><author><name sortKey="Wen, Dr" uniqKey="Wen D">DR Wen</name></author><author><name sortKey="Foshag, Lj" uniqKey="Foshag L">LJ Foshag</name></author><author><name sortKey="Essner, R" uniqKey="Essner R">R Essner</name></author><author><name sortKey="Cochran, A" uniqKey="Cochran A">A Cochran</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Schwartz, Gf" uniqKey="Schwartz G">GF Schwartz</name></author><author><name sortKey="Giuliano, Ae" uniqKey="Giuliano A">AE Giuliano</name></author><author><name sortKey="Veronesi, U" uniqKey="Veronesi U">U Veronesi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van Der Zee, Ag" uniqKey="Van Der Zee A">AG Van der Zee</name></author><author><name sortKey="Oonk, Mh" uniqKey="Oonk M">MH Oonk</name></author><author><name sortKey="De Hullu, Ja" uniqKey="De Hullu J">JA De Hullu</name></author><author><name sortKey="Ansink, Ac" uniqKey="Ansink A">AC Ansink</name></author><author><name sortKey="Vergote, I" uniqKey="Vergote I">I Vergote</name></author><author><name sortKey="Verheijen, Rh" uniqKey="Verheijen R">RH Verheijen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Koh, Wj" uniqKey="Koh W">WJ Koh</name></author><author><name sortKey="Greer, Be" uniqKey="Greer B">BE Greer</name></author><author><name sortKey="Abu Rustum, Nr" uniqKey="Abu Rustum N">NR Abu-Rustum</name></author><author><name sortKey="Apte, Sm" uniqKey="Apte S">SM Apte</name></author><author><name sortKey="Campos, Sm" uniqKey="Campos S">SM Campos</name></author><author><name sortKey="Cho, Kr" uniqKey="Cho K">KR Cho</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Musaev, A" uniqKey="Musaev A">A Musaev</name></author><author><name sortKey="Guzel, Ab" uniqKey="Guzel A">AB Guzel</name></author><author><name sortKey="Khatib, G" uniqKey="Khatib G">G Khatib</name></author><author><name sortKey="Gulec, Uk" uniqKey="Gulec U">UK Gulec</name></author><author><name sortKey="Vardar, Ma" uniqKey="Vardar M">MA Vardar</name></author><author><name sortKey="Altintas, A" uniqKey="Altintas A">A Altintas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ren, Y" uniqKey="Ren Y">Y Ren</name></author><author><name sortKey="Li, Y" uniqKey="Li Y">Y Li</name></author><author><name sortKey="Liu, J" uniqKey="Liu J">J Liu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sardi, Je" uniqKey="Sardi J">JE Sardi</name></author><author><name sortKey="Boixadera, Ma" uniqKey="Boixadera M">MA Boixadera</name></author><author><name sortKey="Sardi, Jj" uniqKey="Sardi J">JJ Sardi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sardi, Je" uniqKey="Sardi J">JE Sardi</name></author><author><name sortKey="Giaroli, A" uniqKey="Giaroli A">A Giaroli</name></author><author><name sortKey="Sananes, C" uniqKey="Sananes C">C Sananes</name></author><author><name sortKey="Ferreira, M" uniqKey="Ferreira M">M Ferreira</name></author><author><name sortKey="Soderini, A" uniqKey="Soderini A">A Soderini</name></author><author><name sortKey="Bermudez, A" uniqKey="Bermudez A">A Bermudez</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Terai, Y" uniqKey="Terai Y">Y Terai</name></author><author><name sortKey="Kanemura, M" uniqKey="Kanemura M">M Kanemura</name></author><author><name sortKey="Sasaki, H" uniqKey="Sasaki H">H Sasaki</name></author><author><name sortKey="Tsunetoh, S" uniqKey="Tsunetoh S">S Tsunetoh</name></author><author><name sortKey="Tanaka, Y" uniqKey="Tanaka Y">Y Tanaka</name></author><author><name sortKey="Yamashita, Y" uniqKey="Yamashita Y">Y Yamashita</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nezhat, Cr" uniqKey="Nezhat C">CR Nezhat</name></author><author><name sortKey="Burrell, Mo" uniqKey="Burrell M">MO Burrell</name></author><author><name sortKey="Nezhat, Fr" uniqKey="Nezhat F">FR Nezhat</name></author><author><name sortKey="Benigno, Bb" uniqKey="Benigno B">BB Benigno</name></author><author><name sortKey="Welander, Ce" uniqKey="Welander C">CE Welander</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nam, Jh" uniqKey="Nam J">JH Nam</name></author><author><name sortKey="Park, Jy" uniqKey="Park J">JY Park</name></author><author><name sortKey="Kim, Dy" uniqKey="Kim D">DY Kim</name></author><author><name sortKey="Kim, Jh" uniqKey="Kim J">JH Kim</name></author><author><name sortKey="Kim, Ym" uniqKey="Kim Y">YM Kim</name></author><author><name sortKey="Kim, Yt" uniqKey="Kim Y">YT Kim</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Abu Rustum, Nr" uniqKey="Abu Rustum N">NR Abu-Rustum</name></author><author><name sortKey="Khoury Collado, F" uniqKey="Khoury Collado F">F Khoury-Collado</name></author><author><name sortKey="Gemignani, Ml" uniqKey="Gemignani M">ML Gemignani</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Eiriksson, Lr" uniqKey="Eiriksson L">LR Eiriksson</name></author><author><name sortKey="Covens, A" uniqKey="Covens A">A Covens</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wang, Xj" uniqKey="Wang X">XJ Wang</name></author><author><name sortKey="Fang, F" uniqKey="Fang F">F Fang</name></author><author><name sortKey="Li, Yf" uniqKey="Li Y">YF Li</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wu, Y" uniqKey="Wu Y">Y Wu</name></author><author><name sortKey="Li, Z" uniqKey="Li Z">Z Li</name></author><author><name sortKey="Wu, H" uniqKey="Wu H">H Wu</name></author><author><name sortKey="Yu, J" uniqKey="Yu J">J Yu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kadkhodayan, S" uniqKey="Kadkhodayan S">S Kadkhodayan</name></author><author><name sortKey="Hasanzadeh, M" uniqKey="Hasanzadeh M">M Hasanzadeh</name></author><author><name sortKey="Treglia, G" uniqKey="Treglia G">G Treglia</name></author><author><name sortKey="Azad, A" uniqKey="Azad A">A Azad</name></author><author><name sortKey="Yousefi, Z" uniqKey="Yousefi Z">Z Yousefi</name></author><author><name sortKey="Zarifmahmoudi, L" uniqKey="Zarifmahmoudi L">L Zarifmahmoudi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nagao, T" uniqKey="Nagao T">T Nagao</name></author><author><name sortKey="Kinoshita, T" uniqKey="Kinoshita T">T Kinoshita</name></author><author><name sortKey="Hojo, T" uniqKey="Hojo T">T Hojo</name></author><author><name sortKey="Kurihara, H" uniqKey="Kurihara H">H Kurihara</name></author><author><name sortKey="Tsuda, H" uniqKey="Tsuda H">H Tsuda</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Imboden, S" uniqKey="Imboden S">S Imboden</name></author><author><name sortKey="Papadia, A" uniqKey="Papadia A">A Papadia</name></author><author><name sortKey="Nauwerk, M" uniqKey="Nauwerk M">M Nauwerk</name></author><author><name sortKey="Mckinnon, B" uniqKey="Mckinnon B">B McKinnon</name></author><author><name sortKey="Kollmann, Z" uniqKey="Kollmann Z">Z Kollmann</name></author><author><name sortKey="Mohr, S" uniqKey="Mohr S">S Mohr</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Buda, A" uniqKey="Buda A">A Buda</name></author><author><name sortKey="Bussi, B" uniqKey="Bussi B">B Bussi</name></author><author><name sortKey="Di Martino, G" uniqKey="Di Martino G">G Di Martino</name></author><author><name sortKey="Di Lorenzo, P" uniqKey="Di Lorenzo P">P Di Lorenzo</name></author><author><name sortKey="Palazzi, S" uniqKey="Palazzi S">S Palazzi</name></author><author><name sortKey="Grassi, T" uniqKey="Grassi T">T Grassi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Buda, A" uniqKey="Buda A">A Buda</name></author><author><name sortKey="Di Martino, G" uniqKey="Di Martino G">G Di Martino</name></author><author><name sortKey="Vecchione, F" uniqKey="Vecchione F">F Vecchione</name></author><author><name sortKey="Bussi, B" uniqKey="Bussi B">B Bussi</name></author><author><name sortKey="Dell Nna, T" uniqKey="Dell Nna T">T Dell’Anna</name></author><author><name sortKey="Palazzi, S" uniqKey="Palazzi S">S Palazzi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Leijte, Ja" uniqKey="Leijte J">JA Leijte</name></author><author><name sortKey="Van Der Ploeg, Im" uniqKey="Van Der Ploeg I">IM van der Ploeg</name></author><author><name sortKey="Valdes Olmos, Ra" uniqKey="Valdes Olmos R">RA Valdés Olmos</name></author><author><name sortKey="Nieweg, Oe" uniqKey="Nieweg O">OE Nieweg</name></author><author><name sortKey="Horenblas, S" uniqKey="Horenblas S">S Horenblas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sethi, D" uniqKey="Sethi D">D Sethi</name></author><author><name sortKey="Sen, R" uniqKey="Sen R">R Sen</name></author><author><name sortKey="Parshad, S" uniqKey="Parshad S">S Parshad</name></author><author><name sortKey="Khetarpal, S" uniqKey="Khetarpal S">S Khetarpal</name></author><author><name sortKey="Garg, M" uniqKey="Garg M">M Garg</name></author><author><name sortKey="Sen, J" uniqKey="Sen J">J Sen</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Gynecol Oncol</journal-id><journal-id journal-id-type="iso-abbrev">J Gynecol Oncol</journal-id><journal-id journal-id-type="publisher-id">JGO</journal-id><journal-title-group><journal-title>Journal of Gynecologic Oncology</journal-title></journal-title-group><issn pub-type="ppub">2005-0380</issn><issn pub-type="epub">2005-0399</issn><publisher><publisher-name>Asian Society of Gynecologic Oncology; Korean Society of Gynecologic Oncology</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27894166</article-id><article-id pub-id-type="pmc">5323283</article-id><article-id pub-id-type="doi">10.3802/jgo.2017.28.e13</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject><subj-group subj-group-type="subheading"><subject>Cervix</subject></subj-group></subj-group></article-categories><title-group><article-title>The detection of sentinel lymph nodes in laparoscopic surgery for uterine cervical cancer using 99m-technetium-tin colloid, indocyanine green, and blue dye</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Tanaka</surname><given-names>Tomohito</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid" authenticated="true">http://orcid.org/0000-0001-8662-7426</contrib-id><name><surname>Terai</surname><given-names>Yoshito</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="true">http://orcid.org/0000-0002-1885-4093</contrib-id><name><surname>Ashihara</surname><given-names>Keisuke</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="true">http://orcid.org/0000-0002-1931-9498</contrib-id><name><surname>Tsunetoh</surname><given-names>Satoshi</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="true">http://orcid.org/0000-0002-8174-6191</contrib-id><name><surname>Akagi</surname><given-names>Hiroyuki</given-names></name><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="true">http://orcid.org/0000-0003-1797-3880</contrib-id><name><surname>Yamada</surname><given-names>Takashi</given-names></name><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Ohmichi</surname><given-names>Masahide</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib></contrib-group><aff id="A1"><label>1</label>Department of Obstetrics and Gynecology, Osaka Medical College, Osaka,<country>Japan</country>.</aff><aff id="A2"><label>2</label>Department of Radiology, Osaka Medical College, Osaka,<country>Japan</country>.</aff><aff id="A3"><label>3</label>Department of Pathology, Osaka Medical College, Osaka,<country>Japan</country>.</aff><author-notes><corresp>Correspondence to Yoshito Terai. Department of Obstetrics and Gynecology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan. <email>y-terai@osaka-med.ac.jp</email></corresp></author-notes><pub-date pub-type="ppub"><month>3</month><year>2017</year></pub-date><pub-date pub-type="epub"><day>01</day><month>11</month><year>2016</year></pub-date><volume>28</volume><issue>2</issue><elocation-id>e13</elocation-id><history><date date-type="received"><day>06</day><month>4</month><year>2016</year></date><date date-type="rev-recd"><day>28</day><month>9</month><year>2016</year></date><date date-type="accepted"><day>21</day><month>10</month><year>2016</year></date></history><permissions><copyright-statement>Copyright © 2017. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology</copyright-statement><copyright-year>2017</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/">http://creativecommons.org/licenses/by-nc/4.0/</ext-link>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><sec><title>Objective</title><p>Our objective was to determine the feasibility and detection rates and clarify the most effective combination of injected tracer types for sentinel lymph node (SLN) mapping in uterine cervical cancer in patients who have undergone laparoscopic surgery or neoadjuvant chemotherapy (NAC).</p></sec><sec><title>Methods</title><p>A total of 119 patients with cervical cancer underwent SLN biopsy at radical hysterectomy using three types of tracers. The various factors related to side-specific detection rate, sensitivity, and false negative (FN) rate were analyzed.</p></sec><sec><title>Results</title><p>The SLN detection rates using 99m-technetium (<sup>99m</sup>Tc)-tin colloid, indigo carmine, and indocyanine green (ICG) were 85.8%, 20.2%, and 61.6%, respectively. The patients with ≥2-cm-diameter tumors and those who received NAC had lower detection rates than those with <2-cm-diameter tumors (75.7% vs. 91.5%, p<0.01) and those who did not receive NAC (67.9% vs. 86.3%, p<0.01), respectively. Laparoscopic procedures had a higher detection rate than laparotomy (100.0% vs. 77.1%, p<0.01). No factors significantly affected the sensitivity; however, the patients with ≥2-cm-diameter tumors (86.0% vs. 1.4%, p<0.01), NAC (19.4% vs. 2.2%, p<0.01), and those who underwent laparotomy (7.4% vs. 0%, p<0.01) had an unfavorable FN rate.</p></sec><sec><title>Conclusion</title><p>Among the examined tracers, <sup>99m</sup>Tc had the highest detection of SLN mapping in patients with uterine cervical cancer. Patients with local advanced cervical cancer with/without NAC treatment might be unsuited for SLN mapping. SLN mapping is feasible and results in an excellent detection rate in patients with <2-cm-diameter cervical cancer. Laparoscopic surgery is the best procedure for SLN detection in patients with early-stage disease.</p></sec></abstract><kwd-group kwd-group-type="author"><kwd>Cervical Cancer</kwd><kwd>Sentinel Lymph Node</kwd><kwd>Laparoscopic Surgery</kwd><kwd>Pelvic Lymph Node</kwd><kwd>Lymph Node Metastasis</kwd></kwd-group></article-meta></front><body><sec sec-type="intro"><title>INTRODUCTION</title><p>Pelvic lymph node dissection (PLND) remains an important surgical procedure in patients undergoing radical hysterectomy for cervical cancer. Although the lymph node status is not included in the current International Federation of Gynecology and Obstetrics (FIGO) staging system [<xref rid="B1" ref-type="bibr">1</xref>], lymph node metastasis is considered to be an important prognostic factor [<xref rid="B2" ref-type="bibr">2</xref><xref rid="B3" ref-type="bibr">3</xref><xref rid="B4" ref-type="bibr">4</xref>]. However, PLND may be associated with many complications, including vascular and nerve injury, increased blood loss, longer surgery, lymphocyst formation, deep venous thromboembolism, and lower limb lymphedema [<xref rid="B5" ref-type="bibr">5</xref><xref rid="B6" ref-type="bibr">6</xref><xref rid="B7" ref-type="bibr">7</xref><xref rid="B8" ref-type="bibr">8</xref>]. To avoid the complications associated with systematic PLND, the sentinel lymph node (SLN) concept has been applied to the treatment of cervical cancer. The SLN mapping technique is based on the principle that the first nodal group receiving lymphatic drainage from a primary tumor can be identified. The utility of SLN mapping has been well established in melanoma, breast cancer, and vulvar cancer [<xref rid="B9" ref-type="bibr">9</xref><xref rid="B10" ref-type="bibr">10</xref><xref rid="B11" ref-type="bibr">11</xref>]. Confirmation of this concept brings benefits to cervical cancer patients. When an SLN can be intraoperatively diagnosed using frozen sections, systematic PLND may be omitted. After SLN mapping and a detailed examination of the SLN, micrometastasis may be found; these patients may receive adjuvant therapy. The National Comprehensive Cancer Network (NCCN) cervical cancer guideline presents SLN mapping as an alternative for the surgical management of early-stage cervical cancer less than 2 cm in diameter [<xref rid="B12" ref-type="bibr">12</xref>].</p><p>Recently, new therapeutic approaches, such as neoadjuvant chemotherapy (NAC) and laparoscopic surgery, for the primary treatment of uterine cervical cancer have been proposed. NAC followed by radical hysterectomy has been proposed to diminish the expansion of tumors and eliminate distant metastasis for locally advanced cervical cancer [<xref rid="B13" ref-type="bibr">13</xref><xref rid="B14" ref-type="bibr">14</xref><xref rid="B15" ref-type="bibr">15</xref><xref rid="B16" ref-type="bibr">16</xref><xref rid="B17" ref-type="bibr">17</xref>]. Laparoscopic radical hysterectomy has also recently been developed for early-stage cervical cancer following its initial introduction in 1992 [<xref rid="B18" ref-type="bibr">18</xref><xref rid="B19" ref-type="bibr">19</xref>]. However, few studies have so far examined the SLN detection rates among different surgical procedures (such as open surgery or laparoscopic surgery) or the influence of pre-surgical treatment (such as diagnostic cervical conization or NAC) on the outcomes of patients with uterine cervical cancer, and the most suitable tracer and the indications for uterine cervical cancer have not been standardized.</p><p>In the present study, we assessed the feasibility and diagnostic accuracy of SLN detection in patients with cervical cancer, including patients who have undergone laparoscopic surgery or NAC.</p></sec><sec sec-type="materials|methods"><title>MATERIALS AND METHODS</title><sec id="sec1"><title>1. Participants</title><p>Between September 2012 and May 2016, a total of 119 Japanese cervical cancer patients underwent a sentinel node procedure at Osaka Medical College in Japan. All of the patients underwent laparoscopic or abdominal radical hysterectomy with or without bilateral salpingo-oophorectomy (BSO) or PLND. The present study was approved by the institutional review board and the participants gave their informed consent.</p></sec><sec id="sec2"><title>2. The SLN mapping procedure</title><p>All of the tracers were sub-mucosally injected in four quadrants of the cervix at 0, 3, 6, and 9 o’clock. The cervical injection was about 5 mm in all cases, as described previously [<xref rid="B20" ref-type="bibr">20</xref><xref rid="B21" ref-type="bibr">21</xref>]. On the day before the operation, 2.0 mL of fluid containing 110 MBq 99m-technetium (<sup>99m</sup>Tc)-labeled tin colloids was injected into the patient’s cervix. Lymphoscintigraphy was performed within 6 hours, and hot spots, indicating SLNs, were identified. On the day of the operation, 5 mL of indigocarmine (IDC) (4 mg/mL) and/or indocyanine green (ICG) (50 µg/mL) was injected into the cervix at the start of surgery. SLN was detected at 40 minutes after injection of IDC or ICG. Radioactive lymph nodes were located using a gamma-probe (Navigator GPS; RMD Instruments Inc., Watertown, MA, USA). IDC-stained lymph nodes were detected by direct inspection. ICG fluorescence-positive lymph nodes were detected using a color fluorescence camera (Hyper Eye Medical System; MIZUHO Medical Co., Ltd., Tokyo, Japan, for laparotomy; Camera Control Unit JC300; MC Medical Co., Tokyo, Japan, for laparoscopy). After SLN biopsy, the area of pelvic lymph node was surveyed by direct observation, and with a color fluorescence camera or a gamma-probe to confirm that no radioactive tissue remained. The combination of <sup>99m</sup>Tc and IDC was used in early phase and combination of three tracers were used in late phase.</p></sec><sec id="sec3"><title>3. Pathology and SLN analyses</title><p>An intraoperative pathological examination was performed. The SLN was cut in half, parallel to the longest axis to obtain a maximal section area. One was used to create a frozen section. The specimen was cut with an interval of 2 mm and a 5 µm section, which was stained with hematoxylin and eosin (H&E), was evaluated at the time that the frozen section was created. The other half and the non-SLN specimens were fixed in 10% formalin for a permanent section procedure; the specimen was cut parallel to the longest axis with an interval of 2 mm. After fixation, the 5 µm-thick sections were stained with H&E and examined.</p></sec><sec id="sec4"><title>4. Detection rate, sensitivity, and false negative rate</title><p><xref ref-type="fig" rid="F1">Fig. 1</xref> shows the calculations of the sensitivity, false negative (FN) rate, and negative predictive value in the study participants. The calculations of each rate were side-specific. The detection rate was defined as the ratio of the number of sides with at least one detected SLN to all sides. The sensitivity was defined as the ratio of the number of sides with at least one involved SLN to the number of sides with at least one involved node among the sides with at least one detected SLN. A FN was defined as ipsilateral pelvic lymph node metastasis without SLN metastasis; the FN rate was defined as the ratio of the number of sides with a FN case of SLN biopsy to the number of patients with at least one involved node, SLN or not, among sides with at least one detected SLN.</p><fig id="F1" fig-type="figure" orientation="portrait" position="float"><label>Fig. 1</label><caption><p>The calculations of the sensitivity, false negative (FN) rate, and negative predictive value in the study participants. The calculations of each rate were side-specific. Among all 119 patients, 116 had systematic pelvic lymph node dissection (PLND). Among these patients, sentinel lymph nodes (SLNs) were detected in 189 sides. Metastasis was identified in 22 SLNs, whereas no metastasis was identified in 167 SLNs. However, 9 metastases were identified in the ipsilateral lymph nodes in 167 sides with no SLN metastasis (FN rate, 9/167). No metastases were identified in the ipsilateral nodes in the remaining 158 sides (negative predictive value, 158/167). Among the 31 sides with metastatic lymph nodes, 22 SLNs had metastasis (sensitivity, 22/31). The detection rate was calculated in a total of 119 patients with 238 sides. The sensitivity and FN rate were calculated in the 116 patients who underwent systematic PLND and 189 sides with detected SLNs. The total detection rate, sensitivity, and FN rate were 81.9% (195/238), 71.0% (22/31), and 5.4% (9/167), respectively.</p></caption><graphic xlink:href="jgo-28-e13-g001"></graphic></fig></sec><sec id="sec5"><title>5. Statistical analysis</title><p>Each rate including the detection rate, sensitivity, and FN rate, was calculated according to the side. All of the statistical analyses were performed using the JMP software package (version 11.1.1; SAS Institute Inc., Cary, NC, USA). Continuous variables are expressed as the mean±standard deviation (SD). The Mann-Whitney U-test was used to compare continuous variables, and Fisher’s exact test was used to compare frequencies. p values of <0.05 were considered to indicate statistical significance.</p></sec></sec><sec sec-type="results"><title>RESULTS</title><p><xref ref-type="table" rid="T1">Table 1</xref> shows the characteristics of 119 patients with uterine cervical cancer who underwent SLN biopsy. The mean age of the patients was 46.0 years, and the mean body mass index (BMI) was 22.5 kg/m<sup>2</sup>. Forty-one (34.5%) patients were nulliparous. A total of 18 patients had FIGO stage IA disease, 50 had stage IB1 disease, 5 had stage IB2 disease, 9 had stage IIA1 disease, 10 had stage IIA2 disease, and 23 had stage IIB disease. Histologically, 74 patients had squamous cell carcinoma and 45 had adenocarcinoma. The SLN procedure was performed with <sup>99m</sup>Tc in 106 (89.1%) patients, IDC in 114 (95.8%) patients, and ICG in 43 (36.1%) patients. Forty-three (36.1%) of the patients had a history of cervical conization and 28 (23.5%) received neoadjuvant intra-arterial chemotherapy (NAIC). The mean tumor size before and after NAC was 4.3±1.2 and 1.4±1.6 cm, respectively. Twenty-five (21.0%) patients underwent laparoscopic surgery; 94 (79.0%) patients underwent laparotomy. A total of 116 (97.5%) patients underwent systematic PLND after SLN biopsy. The mean number of detected SLNs was 2.7±2.0. The total number of resected lymph nodes was 37.4±11.9. <xref ref-type="fig" rid="F1">Fig. 1</xref> shows the calculation of the sensitivity, FN, and negative predictive value in the study participants. The calculations of each rate were side-specific. Among all 119 patients, 116 had systematic PLND. Among these patients, SLNs were detected in 189 sides. Metastasis was identified in 22 SLNs, whereas no metastasis was identified in 167 SLNs. However, 9 metastases were identified in the ipsilateral lymph nodes in 167 sides with no SLN metastasis (FN rate, 9/167). No metastases were identified in the ipsilateral nodes in the remaining 158 sides (negative predictive value, 158/167). Among the 31 sides with metastatic lymph nodes, 22 SLNs had metastasis (sensitivity, 22/31). <xref ref-type="table" rid="T2">Table 2</xref> shows the associations between the detection rate, sensitivity, and FN rate and the related factors. The total detection rate, sensitivity, and FN rate were 81.9% (195/238), 71.0% (22/31), and 5.4% (9/167), respectively. Elderly patients (≥60 years of age) had a lower detection rate than younger patients (<60 years) (65.8% vs. 85.0%, p<0.01). The sensitivity and FN rate did not differ to a statistically significant extent (sensitivity, 57.1% vs. 75.0%, p=0.3; FN, 14.3% vs. 4.1%, p=0.1). The findings for the severely obese (BMI ≥30 kg/m<sup>2</sup>), moderately obese (BMI 25–30 kg/m<sup>2</sup>), and non-obese (BMI <25 kg/m<sup>2</sup>) patients did not differ to a statistically significant extent (detection rate, 93.8% vs. 80.4% vs. 81.2%, p=0.2, p=0.9; sensitivity, 75% vs. 50% vs. 72.0%, p=0.9, p=0.5; FN, 8.3% vs. 3.6% vs. 5.5%, p=0.7, p=0.7, respectively). There was no significant difference between nulliparous and multiparous patients (detection rate, 84.2% vs. 80.8%, p=0.5; sensitivity, 71.4% vs. 70.8%, p=0.6; FN, 3.2% vs. 6.7%, p=0.4). The patients with ≥2-cm-diameter tumors had a lower detection rate (75.7% vs. 91.5%, p<0.01) and a higher FN rate (8.6% vs. 1.4%, p<0.01) than the patients with <2-cm-tumors. Although having a ≥2-cm-diametertumor was associated with lower sensitivity, the difference was not statistically significant (66.7% vs. 85.7%, p=0.4). There was no statistically significant difference between the patients with squamous cell carcinoma and adenocarcinoma (detection rate, 81.8% vs. 82.2%, p=0.9; sensitivity, 71.4% vs. 70.0%, p=1.0; FN, 6.0% vs. 4.5%, p=0.7). <sup>99m</sup>Tc had a higher detection rate than IDC and ICG (85.8% vs. 20.2% and 61.6%, p<0.01). Among the patients without NAC, <sup>99m</sup>Tc also had a higher detection rate than IDC and ICG (90.6% vs. 22.4% and 75.9%, p<0.01). The sensitivity and FN rates of the tracers did not differ to a statistically significant extent. The sensitivity was higher in the patients with history of conization than those without that (91.4% vs. 78.0%, p=0.02). The sensitivity and FN of the patients with and without a history of conization did not differ to a statistically significant extent (sensitivity, 80.0% vs. 69.2%, p=1.0; FN, 1.9% vs. 7.1%, p=0.1). The patients with NAC had a lower detection rate (67.9% vs. 86.3%, p<0.01) and a higher FN rate (19.4% vs. 2.2%, p<0.01) than those without NAC. The patients with NAC had lower sensitivity; however, the difference was not statistically significant (53.9% vs. 83.3%, p=0.1). The patients who underwent a laparoscopic procedure had a higher detection rate (100.0% vs. 77.1%, p<0.01) and lower FN rate (0% vs. 7.4%, p<0.01) than those with laparotomy. The sensitivity did not differ to a statistically significant extent (100.0% vs. 66.7%, p=0.3). Six of the 23 SLNs with metastasis (26.1%) could not be diagnosed using intraoperative frozen sections.</p><table-wrap id="T1" orientation="portrait" position="float"><label>Table 1</label><caption><title>The characteristics of the patients with cervical cancer who underwent a SLN biopsy</title></caption><alternatives><graphic xlink:href="jgo-28-e13-i001"></graphic><table frame="hsides" rules="rows"><col width="5.91%" span="1"></col><col width="60.59%" span="1"></col><col width="33.5%" span="1"></col><thead><tr><th valign="top" align="left" rowspan="1" colspan="2">Total No. of patients</th><th valign="top" align="center" rowspan="1" colspan="1">n=119</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="2" style="background-color:rgb(254,239,212)">Age<sup>*</sup> (yr)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">46.0±10.7</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2">BMI (kg/m<sup>2</sup>)</td><td valign="top" align="center" rowspan="1" colspan="1">22.5±4.3</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2" style="background-color:rgb(254,239,212)">Nulliparous (%)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">41 (34.5)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2">FIGO stage (%)</td><td valign="top" align="center" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">IA</td><td valign="top" align="center" rowspan="1" colspan="1">18 (15.1)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">IB1</td><td valign="top" align="center" rowspan="1" colspan="1">50 (42.0)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">IB2</td><td valign="top" align="center" rowspan="1" colspan="1">5 (4.2)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">IIA1</td><td valign="top" align="center" rowspan="1" colspan="1">9 (7.6)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">IIA2</td><td valign="top" align="center" rowspan="1" colspan="1">10 (8.4)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">IIB</td><td valign="top" align="center" rowspan="1" colspan="1">27 (22.7)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2" style="background-color:rgb(254,239,212)">Histological type (%)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">Squamous cell carcinoma</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">74 (62.2)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">Adenocarcinoma</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">45 (37.8)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2">Tumor diameter (cm)</td><td valign="top" align="center" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"><2</td><td valign="top" align="center" rowspan="1" colspan="1">47 (39.5)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">≥2</td><td valign="top" align="center" rowspan="1" colspan="1">72 (60.5)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2" style="background-color:rgb(254,239,212)">Tracers (%)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"><sup>99m</sup>Tc</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">106 (89.1)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">IDC</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">114 (95.8)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">ICG</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">43 (36.1)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2">History of conization (%)</td><td valign="top" align="center" rowspan="1" colspan="1">35 (29.4)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2" style="background-color:rgb(254,239,212)">NAC (%)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">28 (23.5)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2">Surgical method (%)</td><td valign="top" align="center" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">Laparoscopy</td><td valign="top" align="center" rowspan="1" colspan="1">25 (21.0)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">Laparotomy</td><td valign="top" align="center" rowspan="1" colspan="1">94 (79.0)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">Systematic PLND</td><td valign="top" align="center" rowspan="1" colspan="1">116 (97.5)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2" style="background-color:rgb(254,239,212)">SLNs<sup>*</sup></td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">2.7±2.0</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2">Resected lymph nodes<sup>*</sup></td><td valign="top" align="center" rowspan="1" colspan="1">37.4±11.9</td></tr></tbody></table></alternatives><table-wrap-foot><p>SLN, sentinel lymph node; BMI, body mass index; FIGO, International Federation of Gynecology and Obstetrics; <sup>99m</sup>Tc, 99m-technetium; IDC, indigocarmine; ICG, indocyanine green; NAC, neoadjuvant chemotherapy; PLND, pelvic lymph node dissection; SD, standard deviation.</p><p><sup>*</sup>Mean±SD.</p></table-wrap-foot></table-wrap><table-wrap id="T2" orientation="portrait" position="float"><label>Table 2</label><caption><title>The detection rate, sensitivity and FN rate of SLNs in cervical cancer</title></caption><alternatives><graphic xlink:href="jgo-28-e13-i002"></graphic><table frame="hsides" rules="rows"><col width="3.09%" span="1"></col><col width="17.78%" span="1"></col><col width="16.49%" span="1"></col><col width="10.82%" span="1"></col><col width="15.46%" span="1"></col><col width="10.82%" span="1"></col><col width="14.69%" span="1"></col><col width="10.82%" span="1"></col><thead><tr><th valign="top" align="left" rowspan="1" colspan="2">Factors</th><th valign="top" align="center" rowspan="1" colspan="1">Detection rate (%)</th><th valign="top" align="center" rowspan="1" colspan="1">p value</th><th valign="top" align="center" rowspan="1" colspan="1">Sensitivity (%)</th><th valign="top" align="center" rowspan="1" colspan="1">p value</th><th valign="top" align="center" rowspan="1" colspan="1">FN (%)</th><th valign="top" align="center" rowspan="1" colspan="1">p value</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="2" style="background-color:rgb(254,239,212)">Total</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">195/238 (81.9)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">-</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">22/31 (71.0)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">-</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">9/167 (5.4)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">-</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2">Age (yr)</td><td valign="top" align="center" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="3" colspan="1"><0.01</td><td valign="top" align="center" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="3" colspan="1">0.30</td><td valign="top" align="center" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="3" colspan="1">0.10</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"><60</td><td valign="top" align="center" rowspan="1" colspan="1">170/200 (85.0)</td><td valign="top" align="center" rowspan="1" colspan="1">18/24 (75.0)</td><td valign="top" align="center" rowspan="1" colspan="1">6/146 (4.1)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">≥60</td><td valign="top" align="center" rowspan="1" colspan="1">25/38 (65.8)</td><td valign="top" align="center" rowspan="1" colspan="1">4/7 (57.1)</td><td valign="top" align="center" rowspan="1" colspan="1">3/21 (14.3)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2" style="background-color:rgb(254,239,212)">BMI</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"><25</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">151/186 (81.2)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">18/25 (72.0)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">7/127 (5.5)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">25–30</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">29/36 (80.4)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">0.90</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">1/2 (50.0)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">0.50</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">1/28 (3.6)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">0.70</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">≥30</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">15/16 (93.8)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">0.20</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">3/4 (75.0)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">0.90</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">1/12 (8.3)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">0.70</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2">Parity</td><td valign="top" align="center" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="3" colspan="1">0.50</td><td valign="top" align="center" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="3" colspan="1">0.60</td><td valign="top" align="center" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="3" colspan="1">0.40</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">0</td><td valign="top" align="center" rowspan="1" colspan="1">69/82 (84.2)</td><td valign="top" align="center" rowspan="1" colspan="1">5/7 (71.4)</td><td valign="top" align="center" rowspan="1" colspan="1">2/62 (3.2)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">≥1</td><td valign="top" align="center" rowspan="1" colspan="1">126/156 (80.8)</td><td valign="top" align="center" rowspan="1" colspan="1">17/24 (70.8)</td><td valign="top" align="center" rowspan="1" colspan="1">7/105 (6.7)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2" style="background-color:rgb(254,239,212)">Tumor diameter (cm)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="3" colspan="1" style="background-color:rgb(254,239,212)"><0.01</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="3" colspan="1" style="background-color:rgb(254,239,212)">0.40</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="3" colspan="1" style="background-color:rgb(254,239,212)"><0.01</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"><2</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">86/94 (91.5)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">6/7 (85.7)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">1/74 (1.4)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">≥2</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">109/144 (75.7)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">16/24 (66.7)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">8/93 (8.6)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2">Histological type</td><td valign="top" align="center" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="3" colspan="1">0.90</td><td valign="top" align="center" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="3" colspan="1">0.97</td><td valign="top" align="center" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="3" colspan="1">0.70</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">SCC</td><td valign="top" align="center" rowspan="1" colspan="1">121/148 (81.8)</td><td valign="top" align="center" rowspan="1" colspan="1">15/21 (71.4)</td><td valign="top" align="center" rowspan="1" colspan="1">6/100 (6.0)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">AD</td><td valign="top" align="center" rowspan="1" colspan="1">74/90 (82.2)</td><td valign="top" align="center" rowspan="1" colspan="1">7/10 (70.0)</td><td valign="top" align="center" rowspan="1" colspan="1">3/67 (4.5)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2" style="background-color:rgb(254,239,212)">Tracers</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"><sup>99m</sup>Tc</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">182/212 (85.8)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">19/27 (70.3)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">8/156 (5.1)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">IDC</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">46/228 (20.2)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"><0.01</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">7/8 (87.5)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">0.60</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">1/37 (2.7)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">0.70</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">ICG</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">53/86 (61.6)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"><0.01</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">4/5 (80.0)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">1.00</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">1/49 (2.0)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">0.40</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2">Conization</td><td valign="top" align="center" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="3" colspan="1">0.02</td><td valign="top" align="center" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="3" colspan="1">1.00</td><td valign="top" align="center" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="3" colspan="1">0.10</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">(+)</td><td valign="top" align="center" rowspan="1" colspan="1">64/70 (91.4)</td><td valign="top" align="center" rowspan="1" colspan="1">4/5 (80.0)</td><td valign="top" align="center" rowspan="1" colspan="1">1/54 (1.9)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">(−)</td><td valign="top" align="center" rowspan="1" colspan="1">131/168 (78.0)</td><td valign="top" align="center" rowspan="1" colspan="1">18/26 (69.2)</td><td valign="top" align="center" rowspan="1" colspan="1">8/113 (7.1)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2" style="background-color:rgb(254,239,212)">NAC</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="3" colspan="1" style="background-color:rgb(254,239,212)"><0.01</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="3" colspan="1" style="background-color:rgb(254,239,212)">0.10</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="3" colspan="1" style="background-color:rgb(254,239,212)"><0.01</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">(+)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">38/56 (67.9)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">7/13 (53.9)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">6/31 (19.4)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">(−)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">157/182 (86.3)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">15/18 (83.3)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">3/136 (2.2)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2">Surgical method</td><td valign="top" align="center" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="3" colspan="1"><0.01</td><td valign="top" align="center" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="3" colspan="1">0.30</td><td valign="top" align="center" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="3" colspan="1"><0.01</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">Laparoscopy</td><td valign="top" align="center" rowspan="1" colspan="1">50/50 (100.0)</td><td valign="top" align="center" rowspan="1" colspan="1">4/4 (100.0)</td><td valign="top" align="center" rowspan="1" colspan="1">0/46 (0.0)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">Laparotomy</td><td valign="top" align="center" rowspan="1" colspan="1">145/188 (77.1)</td><td valign="top" align="center" rowspan="1" colspan="1">18/27 (66.7)</td><td valign="top" align="center" rowspan="1" colspan="1">9/121 (7.4)</td></tr></tbody></table></alternatives><table-wrap-foot><p>FN, false negative; SLN, sentinel lymph node; BMI, body mass index; SCC, squamous cell carcinoma; AD, adenocarcinoma; <sup>99m</sup>Tc, 99m-technetium; IDC, indigocarmine; ICG, indocyanine green; NAC, neoadjuvant chemotherapy.</p></table-wrap-foot></table-wrap><p>Next, we evaluated the diagnostic accuracy SLN biopsy specimens obtained from patients with laparoscopy or NAC. The diagnostic accuracy was evaluated in patients with non-bulky cervical cancer (<4 cm in diameter) who underwent laparoscopy and laparotomy, because laparoscopic surgery is not performed to the patients with bulky tumors in our institution. <xref ref-type="table" rid="T3">Table 3</xref> compares the results of laparoscopy and laparotomy in patients with stage IA, IB1, and IIA1 cervical cancer. The age, BMI, proportion of nulliparous patients, and histological types were not significantly different. The patients who underwent laparoscopic procedures had a higher rate of ICG use and a lower rate of IDC use than patients who underwent laparotomy; however, the rate of <sup>99m</sup>Tc use did not differ to a statistically significant extent. More of the patients in the laparotomy group had a history of conization (32.0% vs. 46.2%, p=0.04). Laparoscopic procedures were associated with a higher detection rate than laparotomy (100.0% vs. 87.5%, p<0.01); however, the sensitivity and FN rate were not significantly different (sensitivity, 100.0% vs. 83.3%, p=0.2; FN, 0.0% vs. 1.3%, p=0.4). The diagnostic accuracy of SLN biopsy was evaluated in patients with bulky tumor (≥4 cm in diameter) who received or did not receive NAC, as NAC is performed patients with bulky tumors in our institution. <xref ref-type="table" rid="T4">Table 4</xref> shows the diagnostic accuracy of SLN biopsy in patients with bulky tumors. Among the patients with bulky tumors, the values including detection rate, sensitivity, and FN were not significantly different between the patients with and without NAC.</p><table-wrap id="T3" orientation="portrait" position="float"><label>Table 3</label><caption><title>The results of laparoscopy and laparotomy in patients with stage IA, IB1, and IIA1 cervical cancer</title></caption><alternatives><graphic xlink:href="jgo-28-e13-i003"></graphic><table frame="hsides" rules="rows"><col width="4.51%" span="1"></col><col width="33.46%" span="1"></col><col width="22.56%" span="1"></col><col width="22.56%" span="1"></col><col width="16.92%" span="1"></col><thead><tr><th valign="top" align="left" rowspan="1" colspan="2">Factors</th><th valign="top" align="center" rowspan="1" colspan="1">Laparoscopy</th><th valign="top" align="center" rowspan="1" colspan="1">Laparotomy</th><th valign="top" align="center" rowspan="1" colspan="1">p value</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="2" style="background-color:rgb(254,239,212)">Total</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">25</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">52</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">-</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2">Age<sup>*</sup> (yr)</td><td valign="top" align="center" rowspan="1" colspan="1">45.1±9.1</td><td valign="top" align="center" rowspan="1" colspan="1">44.0±10.0</td><td valign="top" align="center" rowspan="1" colspan="1">0.50</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2" style="background-color:rgb(254,239,212)">BMI (kg/m<sup>2</sup>)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">21.8±4.0</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">23.0±4.5</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">0.20</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2">Nulliparous</td><td valign="top" align="center" rowspan="1" colspan="1">7 (28.0)</td><td valign="top" align="center" rowspan="1" colspan="1">19 (36.5)</td><td valign="top" align="center" rowspan="1" colspan="1">0.50</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2" style="background-color:rgb(254,239,212)">Histological type</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="3" colspan="1" style="background-color:rgb(254,239,212)">0.30</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">Squamous cell carcinoma</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">12 (48.0)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">32 (61.5)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">Adenocarcinoma</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">13 (52.0)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">20 (38.5)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2">Tumor diameter size (cm)</td><td valign="top" align="center" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="3" colspan="1">0.20</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"><2</td><td valign="top" align="center" rowspan="1" colspan="1">13 (52.0)</td><td valign="top" align="center" rowspan="1" colspan="1">18 (34.6)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">≥2</td><td valign="top" align="center" rowspan="1" colspan="1">12(48.0)</td><td valign="top" align="center" rowspan="1" colspan="1">34 (65.4)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2" style="background-color:rgb(254,239,212)">Tracers</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"><sup>99m</sup>Tc</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">22 (88.0)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">47 (90.4)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">0.80</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">IDC</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">20 (80.0)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">52 (100.0)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"><0.01</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">ICG</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">18 (72.0)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">9 (17.3)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"><0.01</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2">History of conization</td><td valign="top" align="center" rowspan="1" colspan="1">8 (32.0)</td><td valign="top" align="center" rowspan="1" colspan="1">24 (46.2)</td><td valign="top" align="center" rowspan="1" colspan="1">0.04</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2" style="background-color:rgb(254,239,212)">Detection rate</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">50/50 (100.0)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">91/104 (87.5)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"><0.01</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2">Sensitivity</td><td valign="top" align="center" rowspan="1" colspan="1">4/4 (100.0)</td><td valign="top" align="center" rowspan="1" colspan="1">5/6 (83.3)</td><td valign="top" align="center" rowspan="1" colspan="1">0.20</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2" style="background-color:rgb(254,239,212)">FN rate</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">0/46 (0.0)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">1/79 (1.3)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">0.40</td></tr></tbody></table></alternatives><table-wrap-foot><p>BMI, body mass index; FN, false negative; ICG, indocyanine green; IDC, indigocarmine; SD, standard deviation; <sup>99m</sup>Tc, 99m-technetium.</p><p><sup>*</sup>Based on an analysis of variance (ANOVA, mean±SD).</p></table-wrap-foot></table-wrap><table-wrap id="T4" orientation="portrait" position="float"><label>Table 4</label><caption><title>The results of NAC in patients with bulky tumors</title></caption><alternatives><graphic xlink:href="jgo-28-e13-i004"></graphic><table frame="hsides" rules="rows"><col width="4.48%" span="1"></col><col width="35.07%" span="1"></col><col width="22.39%" span="1"></col><col width="22.39%" span="1"></col><col width="15.67%" span="1"></col><thead><tr><th valign="top" align="left" rowspan="1" colspan="2">Factors</th><th valign="top" align="center" rowspan="1" colspan="1">NAC (+)</th><th valign="top" align="center" rowspan="1" colspan="1">NAC (−)</th><th valign="top" align="center" rowspan="1" colspan="1">p value</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="2" style="background-color:rgb(254,239,212)">Total</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">28</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">16</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">-</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2">Age<sup>*</sup> (yr)</td><td valign="top" align="center" rowspan="1" colspan="1">48.3±10.8</td><td valign="top" align="center" rowspan="1" colspan="1">49.9±13.5</td><td valign="top" align="center" rowspan="1" colspan="1">0.7</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2" style="background-color:rgb(254,239,212)">BMI (kg/m<sup>2</sup>)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">21.7±4.6</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">22.1±4.1</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">0.8</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2">Nulliparous</td><td valign="top" align="center" rowspan="1" colspan="1">11</td><td valign="top" align="center" rowspan="1" colspan="1">4</td><td valign="top" align="center" rowspan="1" colspan="1">0.3</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2" style="background-color:rgb(254,239,212)">Histological type</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="3" colspan="1" style="background-color:rgb(254,239,212)">0.1</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">Squamous cell carcinoma</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">22</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">7</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">Adenocarcinoma</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">6</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">9</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2">Stage</td><td valign="top" align="center" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="4" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">IB2</td><td valign="top" align="center" rowspan="1" colspan="1">4</td><td valign="top" align="center" rowspan="1" colspan="1">3</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">IIA2</td><td valign="top" align="center" rowspan="1" colspan="1">6</td><td valign="top" align="center" rowspan="1" colspan="1">8</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">IIB</td><td valign="top" align="center" rowspan="1" colspan="1">18</td><td valign="top" align="center" rowspan="1" colspan="1">5</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2" style="background-color:rgb(254,239,212)">Tracers</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"><sup>99m</sup>Tc</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">26 (92.9)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">13 (81.3)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">0.2</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">IDC</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">28 (100.0)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">16 (100.0)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)"></td><td valign="top" align="left" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">ICG</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">13 (46.4)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">4 (25.0)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">0.2</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2">Detection rate</td><td valign="top" align="center" rowspan="1" colspan="1">38/56 (67.9)</td><td valign="top" align="center" rowspan="1" colspan="1">20/32 (62.5)</td><td valign="top" align="center" rowspan="1" colspan="1">0.4</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2" style="background-color:rgb(254,239,212)">Sensitivity</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">7/13 (53.8)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">7/9 (77.8)</td><td valign="top" align="center" rowspan="1" colspan="1" style="background-color:rgb(254,239,212)">0.3</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="2">FN rate</td><td valign="top" align="center" rowspan="1" colspan="1">6/31 (19.4)</td><td valign="top" align="center" rowspan="1" colspan="1">2/13 (15.4)</td><td valign="top" align="center" rowspan="1" colspan="1">0.8</td></tr></tbody></table></alternatives><table-wrap-foot><p>BMI, body mass index; NAC, neoadjuvant chemotherapy; FN, false negative; ICG, indocyanine green; IDC, indigocarmine; SD, standard deviation; <sup>99m</sup>Tc, 99m-technetium.</p><p><sup>*</sup>Based on an analysis of variance (ANOVA, mean±SD).</p></table-wrap-foot></table-wrap></sec><sec sec-type="discussion"><title>DISCUSSION</title><p>In the current study, <sup>99m</sup>Tc had the highest detection rate of the three tracers. In contrast, the use of IDC was associated with a low detection rate. The patients with advanced disease and NAC had unfavorable detection and FN rates. In contrast, laparoscopic procedures were associated with especially favorable figures in patients with early-stage disease. Several factors, including BMI, parity, histological type, and a history of conization had no significant impact on the detection rate, sensitivity or FN rate.</p><p>A meta-analysis showed that the SLN detection rate in cervical cancer was 89.2%–93.0% [<xref rid="B22" ref-type="bibr">22</xref><xref rid="B23" ref-type="bibr">23</xref><xref rid="B24" ref-type="bibr">24</xref>]. The detection rates with blue dye, the isotope and a combination of both tracers were 80.9%–87.5%, 90.0%–90.9%, and 92.3%–97.0%, respectively. Although one author concluded that there were no significant differences between the tracers, others did not. IDC was used as the blue dye tracer in the current study. In Japan, SLN biopsy using IDC has been performed since 1998, mainly in breast cancer [<xref rid="B25" ref-type="bibr">25</xref>]. Its molecular mass is 466.4, which is similar to patent blue and isosulfan blue; however, the detection rate using IDC was extremely low in the current study. In contrast, ICG (a fluorescent dye) has a molecular mass of 775. Although SLN biopsy using ICG requires a fluorescence system, several reports have shown that ICG has a feasible detection rate in patients with uterine cervical cancer [<xref rid="B26" ref-type="bibr">26</xref><xref rid="B27" ref-type="bibr">27</xref><xref rid="B28" ref-type="bibr">28</xref>]. On the other hand, in the patients with uterine cervical cancer, the sensitivity of radiotracers has been reported to be 87.0%–94.4% [<xref rid="B22" ref-type="bibr">22</xref><xref rid="B23" ref-type="bibr">23</xref><xref rid="B24" ref-type="bibr">24</xref>]. The use of a radiotracer in combination with blue dye did not increase the sensitivity to a significant extent (88.0%–91.3%). Similarly, blue dye used alone did not decrease the sensitivity to a significant extent (86.3%–87.2%) [<xref rid="B22" ref-type="bibr">22</xref><xref rid="B23" ref-type="bibr">23</xref><xref rid="B24" ref-type="bibr">24</xref>]. The sensitivity with fluorescent imaging was 90.9% [<xref rid="B24" ref-type="bibr">24</xref>]. Based on the results of the current study, we believe that SLN biopsy using a radiotracer is the most useful method of SLN detection in patients with uterine cervical cancer.</p><p>A large tumor size and an advanced stage were associated with lower detection rate and sensitivity [<xref rid="B24" ref-type="bibr">24</xref>]. The detection rate and sensitivity were lower in the patients with advanced-stage cancer (>IB2) than in patients with early-stage cancer (≤IB2) (detection rate, 65.9% vs. 93.6%; sensitivity, 87% vs. 91.4%) [<xref rid="B24" ref-type="bibr">24</xref>]. Similarly, the detection rate and sensitivity were lower in patients with large-sized tumors (>2 cm) than in those with small tumors (≤2 cm) (detection rate, 73.9% vs. 93.4%; sensitivity, 81.7% vs. 94.7%) [<xref rid="B24" ref-type="bibr">24</xref>]. In those patients, the lymphatic tract may be destroyed and the rate of lymph node metastasis is higher. In such cases, non-involved lymph nodes may be detected as SLNs, because the original SLN is completely replaced with cancer cells [<xref rid="B29" ref-type="bibr">29</xref>]. The reason for the failure of lymphatic mapping in large or locally advanced tumors is the higher possibility of lymph nodal involvement and lymphovascular invasion, which hampers lymphatic flow, than with smaller tumors [<xref rid="B24" ref-type="bibr">24</xref>]. NAC followed by radical hysterectomy has been proposed to diminish the expansion of tumors and eliminate distant metastasis for locally advanced cervical cancer [<xref rid="B13" ref-type="bibr">13</xref><xref rid="B14" ref-type="bibr">14</xref><xref rid="B15" ref-type="bibr">15</xref><xref rid="B16" ref-type="bibr">16</xref><xref rid="B17" ref-type="bibr">17</xref>]. In this study, the patients with NAC had a lower detection rate (67.9% vs. 86.3%, p<0.01) and a higher FN rate (19.4% vs. 2.2%, p<0.01) than those without NAC, as found in a previous report [<xref rid="B24" ref-type="bibr">24</xref>]. Basically, preoperative treatment is administered to cervical cancer patients who have bulky tumors [<xref rid="B13" ref-type="bibr">13</xref>]. NAC might be associated with a better detection rate due to the regression of the tumor in the lymphatic drainage or lymph nodes. However, the detection rate among the patients with bulky tumors was not significantly different between the patients with and without NAC in our study (68% vs. 60%, p=0.4). Some prominent findings after NAC treatment were elastosis, collageniztion, hyalinaization, and microcalicification of the stroma; hyalinization of the walls of the blood vessels; and necrosis [<xref rid="B30" ref-type="bibr">30</xref>]. These changes suggest that NAC might induce blocking or rerouting of the lymphatic drainage of the primary tumor. Our data further suggest that the unfavorable results after NAC were caused by not only the presence of large and advanced tumors but also the chemotherapy itself. We believe that patients who have received NAC for locally advanced cervical cancer might be unsuitable for SLN mapping.</p><p>The injection of tracers to patients with a history of conization is difficult and conization may hamper lymphatic flow. However, in line with the results of a previous study, we found that a history of conization was not associated with a lower detection rate [<xref rid="B24" ref-type="bibr">24</xref>].</p><p>The detection rates in patients who underwent laparoscopic surgery and open surgery were 93.0%–96.1% and 87.0%–90.2%, respectively. The sensitivity in these patients was 89.8%–93.2% and 86.0%–91.7%, respectively [<xref rid="B22" ref-type="bibr">22</xref><xref rid="B23" ref-type="bibr">23</xref><xref rid="B24" ref-type="bibr">24</xref>]. These results suggest that laparoscopic procedures have excellent potential in detecting SLNs in patients with early cervical cancer. In our study, laparoscopic procedure had higher detection rate than laparotomy. We believe that a wide and clear view by laparoscopy improves the detection rate; in more patients with higher detection rate under laparoscopy, systematic PLND could be omitted.</p><p>This study is associated with two important limitations that may potentially decrease its value. First, a multivariate analysis could not be performed due to the small study size. Second, the study included a number of biases. For example, most of the patients who received NAC had advanced disease. Similarly, most of the patients with a history of conization or those who underwent a laparoscopic procedure had early disease. In this point of view, the conclusion is not definitive.</p><p>In conclusion, <sup>99m</sup>Tc had the highest detection rate of the three tracers. The patients with advanced-stage cancer and those who received NAC had an unfavorable detection rate and FN. In contrast laparoscopic surgery was associated with a favorable detection rate and FN, especially in patients with early-stage disease. To avoid systematic PLND, SLN biopsy should be performed during laparoscopic surgery in patients with early-stage disease. Laparoscopic devices may be useful for this SLN procedure.</p></sec></body><back><fn-group><fn fn-type="COI-statement"><p><bold>Conflict of Interest:</bold> No potential conflict of interest relevant to this article was reported.</p></fn></fn-group><ref-list><ref id="B1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pecorelli</surname><given-names>S</given-names></name><name><surname>Zigliani</surname><given-names>L</given-names></name><name><surname>Odicino</surname><given-names>F</given-names></name></person-group><article-title>Revised FIGO staging for carcinoma of the cervix</article-title><source>Int J Gynaecol Obstet</source><year>2009</year><volume>105</volume><fpage>107</fpage><lpage>108</lpage><pub-id pub-id-type="pmid">19342051</pub-id></element-citation></ref><ref id="B2"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Delgado</surname><given-names>G</given-names></name><name><surname>Bundy</surname><given-names>B</given-names></name><name><surname>Zaino</surname><given-names>R</given-names></name><name><surname>Sevin</surname><given-names>BU</given-names></name><name><surname>Creasman</surname><given-names>WT</given-names></name><name><surname>Major</surname><given-names>F</given-names></name></person-group><article-title>Prospective surgical-pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study</article-title><source>Gynecol Oncol</source><year>1990</year><volume>38</volume><fpage>352</fpage><lpage>357</lpage><pub-id pub-id-type="pmid">2227547</pub-id></element-citation></ref><ref id="B3"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Yuan</surname><given-names>C</given-names></name><name><surname>Wang</surname><given-names>P</given-names></name><name><surname>Lai</surname><given-names>C</given-names></name><name><surname>Tsu</surname><given-names>E</given-names></name><name><surname>Yen</surname><given-names>M</given-names></name><name><surname>Ng</surname><given-names>H</given-names></name></person-group><article-title>Recurrence and survival analyses of 1,115 cervical cancer patients treated with radical hysterectomy</article-title><source>Gynecol Obstet Invest</source><year>1999</year><volume>47</volume><fpage>127</fpage><lpage>132</lpage><pub-id pub-id-type="pmid">9949284</pub-id></element-citation></ref><ref id="B4"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Biewenga</surname><given-names>P</given-names></name><name><surname>van der Velden</surname><given-names>J</given-names></name><name><surname>Mol</surname><given-names>BW</given-names></name><name><surname>Stalpers</surname><given-names>LJ</given-names></name><name><surname>Schilthuis</surname><given-names>MS</given-names></name><name><surname>van der Steeg</surname><given-names>JW</given-names></name><etal></etal></person-group><article-title>Prognostic model for survival in patients with early stage cervical cancer</article-title><source>Cancer</source><year>2011</year><volume>117</volume><fpage>768</fpage><lpage>776</lpage><pub-id pub-id-type="pmid">20922801</pub-id></element-citation></ref><ref id="B5"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kim</surname><given-names>SI</given-names></name><name><surname>Lim</surname><given-names>MC</given-names></name><name><surname>Lee</surname><given-names>JS</given-names></name><name><surname>Lee</surname><given-names>Y</given-names></name><name><surname>Park</surname><given-names>K</given-names></name><name><surname>Joo</surname><given-names>J</given-names></name><etal></etal></person-group><article-title>Impact of lower limb lymphedema on quality of life in gynecologic cancer survivors after pelvic lymph node dissection</article-title><source>Eur J Obstet Gynecol Reprod Biol</source><year>2015</year><volume>192</volume><fpage>31</fpage><lpage>36</lpage><pub-id pub-id-type="pmid">26142914</pub-id></element-citation></ref><ref id="B6"><label>6</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Tanaka</surname><given-names>T</given-names></name><name><surname>Terai</surname><given-names>Y</given-names></name><name><surname>Ono</surname><given-names>YJ</given-names></name><name><surname>Fujiwara</surname><given-names>S</given-names></name><name><surname>Tanaka</surname><given-names>Y</given-names></name><name><surname>Sasaki</surname><given-names>H</given-names></name><etal></etal></person-group><article-title>Genitofemoral neuropathy after pelvic lymphadenectomy in patients with uterine corpus cancer</article-title><source>Int J Gynecol Cancer</source><year>2015</year><volume>25</volume><fpage>533</fpage><lpage>536</lpage><pub-id pub-id-type="pmid">25486104</pub-id></element-citation></ref><ref id="B7"><label>7</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Abu-Rustum</surname><given-names>NR</given-names></name><name><surname>Alektiar</surname><given-names>K</given-names></name><name><surname>Iasonos</surname><given-names>A</given-names></name><name><surname>Lev</surname><given-names>G</given-names></name><name><surname>Sonoda</surname><given-names>Y</given-names></name><name><surname>Aghajanian</surname><given-names>C</given-names></name><etal></etal></person-group><article-title>The incidence of symptomatic lower-extremity lymphedema following treatment of uterine corpus malignancies: a 12-year experience at Memorial Sloan-Kettering Cancer Center</article-title><source>Gynecol Oncol</source><year>2006</year><volume>103</volume><fpage>714</fpage><lpage>718</lpage><pub-id pub-id-type="pmid">16740298</pub-id></element-citation></ref><ref id="B8"><label>8</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Homesley</surname><given-names>HD</given-names></name><name><surname>Kadar</surname><given-names>N</given-names></name><name><surname>Barrett</surname><given-names>RJ</given-names></name><name><surname>Lentz</surname><given-names>SS</given-names></name></person-group><article-title>Selective pelvic and periaortic lymphadenectomy does not increase morbidity in surgical staging of endometrial carcinoma</article-title><source>Am J Obstet Gynecol</source><year>1992</year><volume>167</volume><fpage>1225</fpage><lpage>1230</lpage><pub-id pub-id-type="pmid">1442971</pub-id></element-citation></ref><ref id="B9"><label>9</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Morton</surname><given-names>DL</given-names></name><name><surname>Wen</surname><given-names>DR</given-names></name><name><surname>Foshag</surname><given-names>LJ</given-names></name><name><surname>Essner</surname><given-names>R</given-names></name><name><surname>Cochran</surname><given-names>A</given-names></name></person-group><article-title>Intraoperative lymphatic mapping and selective cervical lymphadenectomy for early-stage melanomas of the head and neck</article-title><source>J Clin Oncol</source><year>1993</year><volume>11</volume><fpage>1751</fpage><lpage>1756</lpage><pub-id pub-id-type="pmid">8355042</pub-id></element-citation></ref><ref id="B10"><label>10</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Schwartz</surname><given-names>GF</given-names></name><name><surname>Giuliano</surname><given-names>AE</given-names></name><name><surname>Veronesi</surname><given-names>U</given-names></name><collab>Consensus Conference Committee</collab></person-group><article-title>Proceedings of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast, April 19-22, 2001, Philadelphia, Pennsylvania</article-title><source>Cancer</source><year>2002</year><volume>94</volume><fpage>2542</fpage><lpage>2551</lpage><pub-id pub-id-type="pmid">12173319</pub-id></element-citation></ref><ref id="B11"><label>11</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Van der Zee</surname><given-names>AG</given-names></name><name><surname>Oonk</surname><given-names>MH</given-names></name><name><surname>De Hullu</surname><given-names>JA</given-names></name><name><surname>Ansink</surname><given-names>AC</given-names></name><name><surname>Vergote</surname><given-names>I</given-names></name><name><surname>Verheijen</surname><given-names>RH</given-names></name><etal></etal></person-group><article-title>Sentinel node dissection is safe in the treatment of early-stage vulvar cancer</article-title><source>J Clin Oncol</source><year>2008</year><volume>26</volume><fpage>884</fpage><lpage>889</lpage><pub-id pub-id-type="pmid">18281661</pub-id></element-citation></ref><ref id="B12"><label>12</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Koh</surname><given-names>WJ</given-names></name><name><surname>Greer</surname><given-names>BE</given-names></name><name><surname>Abu-Rustum</surname><given-names>NR</given-names></name><name><surname>Apte</surname><given-names>SM</given-names></name><name><surname>Campos</surname><given-names>SM</given-names></name><name><surname>Cho</surname><given-names>KR</given-names></name><etal></etal></person-group><article-title>Cervical cancer, version 2.2015</article-title><source>J Natl Compr Canc Netw</source><year>2015</year><volume>13</volume><fpage>395</fpage><lpage>404</lpage><pub-id pub-id-type="pmid">25870376</pub-id></element-citation></ref><ref id="B13"><label>13</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Musaev</surname><given-names>A</given-names></name><name><surname>Guzel</surname><given-names>AB</given-names></name><name><surname>Khatib</surname><given-names>G</given-names></name><name><surname>Gulec</surname><given-names>UK</given-names></name><name><surname>Vardar</surname><given-names>MA</given-names></name><name><surname>Altintas</surname><given-names>A</given-names></name><etal></etal></person-group><article-title>Assessment of primary radical hysterectomy and neoadjuvant chemotherapy followed by radical hysterectomy in Stage IB2, IIA bulky cervical cancer</article-title><source>Eur J Gynaecol Oncol</source><year>2015</year><volume>36</volume><fpage>579</fpage><lpage>584</lpage><pub-id pub-id-type="pmid">26513887</pub-id></element-citation></ref><ref id="B14"><label>14</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ren</surname><given-names>Y</given-names></name><name><surname>Li</surname><given-names>Y</given-names></name><name><surname>Liu</surname><given-names>J</given-names></name></person-group><article-title>A modified shortened administration schedule for neoadjuvant chemotherapy with irinotecan and cisplatin in locally advanced cervical cancer</article-title><source>Int J Gynecol Cancer</source><year>2011</year><volume>21</volume><fpage>685</fpage><lpage>689</lpage><pub-id pub-id-type="pmid">21543932</pub-id></element-citation></ref><ref id="B15"><label>15</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sardi</surname><given-names>JE</given-names></name><name><surname>Boixadera</surname><given-names>MA</given-names></name><name><surname>Sardi</surname><given-names>JJ</given-names></name></person-group><article-title>Neoadjuvant chemotherapy in cervical cancer: a new trend</article-title><source>Curr Opin Obstet Gynecol</source><year>2005</year><volume>17</volume><fpage>43</fpage><lpage>47</lpage><pub-id pub-id-type="pmid">15711410</pub-id></element-citation></ref><ref id="B16"><label>16</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sardi</surname><given-names>JE</given-names></name><name><surname>Giaroli</surname><given-names>A</given-names></name><name><surname>Sananes</surname><given-names>C</given-names></name><name><surname>Ferreira</surname><given-names>M</given-names></name><name><surname>Soderini</surname><given-names>A</given-names></name><name><surname>Bermudez</surname><given-names>A</given-names></name><etal></etal></person-group><article-title>Long-term follow-up of the first randomized trial using neoadjuvant chemotherapy in stage Ib squamous carcinoma of the cervix: the final results</article-title><source>Gynecol Oncol</source><year>1997</year><volume>67</volume><fpage>61</fpage><lpage>69</lpage><pub-id pub-id-type="pmid">9345358</pub-id></element-citation></ref><ref id="B17"><label>17</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Terai</surname><given-names>Y</given-names></name><name><surname>Kanemura</surname><given-names>M</given-names></name><name><surname>Sasaki</surname><given-names>H</given-names></name><name><surname>Tsunetoh</surname><given-names>S</given-names></name><name><surname>Tanaka</surname><given-names>Y</given-names></name><name><surname>Yamashita</surname><given-names>Y</given-names></name><etal></etal></person-group><article-title>Long-term follow-up of neoadjuvant intraarterial chemotherapy using an original four-lumen double-balloon (4L-DB) catheter for locally advanced uterine cervical cancer</article-title><source>Int J Clin Oncol</source><year>2009</year><volume>14</volume><fpage>56</fpage><lpage>62</lpage><pub-id pub-id-type="pmid">19225926</pub-id></element-citation></ref><ref id="B18"><label>18</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Nezhat</surname><given-names>CR</given-names></name><name><surname>Burrell</surname><given-names>MO</given-names></name><name><surname>Nezhat</surname><given-names>FR</given-names></name><name><surname>Benigno</surname><given-names>BB</given-names></name><name><surname>Welander</surname><given-names>CE</given-names></name></person-group><article-title>Laparoscopic radical hysterectomy with paraaortic and pelvic node dissection</article-title><source>Am J Obstet Gynecol</source><year>1992</year><volume>166</volume><fpage>864</fpage><lpage>865</lpage><pub-id pub-id-type="pmid">1532291</pub-id></element-citation></ref><ref id="B19"><label>19</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Nam</surname><given-names>JH</given-names></name><name><surname>Park</surname><given-names>JY</given-names></name><name><surname>Kim</surname><given-names>DY</given-names></name><name><surname>Kim</surname><given-names>JH</given-names></name><name><surname>Kim</surname><given-names>YM</given-names></name><name><surname>Kim</surname><given-names>YT</given-names></name></person-group><article-title>Laparoscopic versus open radical hysterectomy in early-stage cervical cancer: long-term survival outcomes in a matched cohort study</article-title><source>Ann Oncol</source><year>2012</year><volume>23</volume><fpage>903</fpage><lpage>911</lpage><pub-id pub-id-type="pmid">21841155</pub-id></element-citation></ref><ref id="B20"><label>20</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Abu-Rustum</surname><given-names>NR</given-names></name><name><surname>Khoury-Collado</surname><given-names>F</given-names></name><name><surname>Gemignani</surname><given-names>ML</given-names></name></person-group><article-title>Techniques of sentinel lymph node identification for early-stage cervical and uterine cancer</article-title><source>Gynecol Oncol</source><year>2008</year><volume>111</volume><issue>Suppl</issue><fpage>S44</fpage><lpage>50</lpage><pub-id pub-id-type="pmid">18760450</pub-id></element-citation></ref><ref id="B21"><label>21</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Eiriksson</surname><given-names>LR</given-names></name><name><surname>Covens</surname><given-names>A</given-names></name></person-group><article-title>Sentinel lymph node mapping in cervical cancer: the future?</article-title><source>BJOG</source><year>2012</year><volume>119</volume><fpage>129</fpage><lpage>133</lpage><pub-id pub-id-type="pmid">21917113</pub-id></element-citation></ref><ref id="B22"><label>22</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname><given-names>XJ</given-names></name><name><surname>Fang</surname><given-names>F</given-names></name><name><surname>Li</surname><given-names>YF</given-names></name></person-group><article-title>Sentinel-lymph-node procedures in early stage cervical cancer: a systematic review and meta-analysis</article-title><source>Med Oncol</source><year>2015</year><volume>32</volume><fpage>385</fpage><pub-id pub-id-type="pmid">25429838</pub-id></element-citation></ref><ref id="B23"><label>23</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wu</surname><given-names>Y</given-names></name><name><surname>Li</surname><given-names>Z</given-names></name><name><surname>Wu</surname><given-names>H</given-names></name><name><surname>Yu</surname><given-names>J</given-names></name></person-group><article-title>Sentinel lymph node biopsy in cervical cancer: A meta-analysis</article-title><source>Mol Clin Oncol</source><year>2013</year><volume>1</volume><fpage>1025</fpage><lpage>1030</lpage><pub-id pub-id-type="pmid">24649288</pub-id></element-citation></ref><ref id="B24"><label>24</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kadkhodayan</surname><given-names>S</given-names></name><name><surname>Hasanzadeh</surname><given-names>M</given-names></name><name><surname>Treglia</surname><given-names>G</given-names></name><name><surname>Azad</surname><given-names>A</given-names></name><name><surname>Yousefi</surname><given-names>Z</given-names></name><name><surname>Zarifmahmoudi</surname><given-names>L</given-names></name><etal></etal></person-group><article-title>Sentinel node biopsy for lymph nodal staging of uterine cervix cancer: a systematic review and meta-analysis of the pertinent literature</article-title><source>Eur J Surg Oncol</source><year>2015</year><volume>41</volume><fpage>1</fpage><lpage>20</lpage><pub-id pub-id-type="pmid">25454828</pub-id></element-citation></ref><ref id="B25"><label>25</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Nagao</surname><given-names>T</given-names></name><name><surname>Kinoshita</surname><given-names>T</given-names></name><name><surname>Hojo</surname><given-names>T</given-names></name><name><surname>Kurihara</surname><given-names>H</given-names></name><name><surname>Tsuda</surname><given-names>H</given-names></name></person-group><article-title>Sentinel lymph node biopsy using indigo carmine blue dye and the validity of ‘10% rule’ and ‘4 nodes rule’</article-title><source>Breast</source><year>2012</year><volume>21</volume><fpage>455</fpage><lpage>458</lpage><pub-id pub-id-type="pmid">22119457</pub-id></element-citation></ref><ref id="B26"><label>26</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Imboden</surname><given-names>S</given-names></name><name><surname>Papadia</surname><given-names>A</given-names></name><name><surname>Nauwerk</surname><given-names>M</given-names></name><name><surname>McKinnon</surname><given-names>B</given-names></name><name><surname>Kollmann</surname><given-names>Z</given-names></name><name><surname>Mohr</surname><given-names>S</given-names></name><etal></etal></person-group><article-title>A comparison of radiocolloid and indocyanine green fluorescence imaging, sentinel lymph node mapping in patients with cervical cancer undergoing laparoscopic surgery</article-title><source>Ann Surg Oncol</source><year>2015</year><volume>22</volume><fpage>4198</fpage><lpage>4203</lpage><pub-id pub-id-type="pmid">26122376</pub-id></element-citation></ref><ref id="B27"><label>27</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Buda</surname><given-names>A</given-names></name><name><surname>Bussi</surname><given-names>B</given-names></name><name><surname>Di Martino</surname><given-names>G</given-names></name><name><surname>Di Lorenzo</surname><given-names>P</given-names></name><name><surname>Palazzi</surname><given-names>S</given-names></name><name><surname>Grassi</surname><given-names>T</given-names></name><etal></etal></person-group><article-title>Sentinel lymph node mapping with near-infrared fluorescent imaging using indocyanine green: a new tool for laparoscopic platform in patients with endometrial and cervical cancer</article-title><source>J Minim Invasive Gynecol</source><year>2016</year><volume>23</volume><fpage>265</fpage><lpage>269</lpage><pub-id pub-id-type="pmid">26455525</pub-id></element-citation></ref><ref id="B28"><label>28</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Buda</surname><given-names>A</given-names></name><name><surname>Di Martino</surname><given-names>G</given-names></name><name><surname>Vecchione</surname><given-names>F</given-names></name><name><surname>Bussi</surname><given-names>B</given-names></name><name><surname>Dell’Anna</surname><given-names>T</given-names></name><name><surname>Palazzi</surname><given-names>S</given-names></name><etal></etal></person-group><article-title>Optimizing strategies for sentinel lymph node mapping in early-stage cervical and endometrial cancer: comparison of real-time fluorescence with indocyanine green and methylene blue</article-title><source>Int J Gynecol Cancer</source><year>2015</year><volume>25</volume><fpage>1513</fpage><lpage>1518</lpage><pub-id pub-id-type="pmid">26397069</pub-id></element-citation></ref><ref id="B29"><label>29</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Leijte</surname><given-names>JA</given-names></name><name><surname>van der Ploeg</surname><given-names>IM</given-names></name><name><surname>Valdés Olmos</surname><given-names>RA</given-names></name><name><surname>Nieweg</surname><given-names>OE</given-names></name><name><surname>Horenblas</surname><given-names>S</given-names></name></person-group><article-title>Visualization of tumor blockage and rerouting of lymphatic drainage in penile cancer patients by use of SPECT/CT</article-title><source>J Nucl Med</source><year>2009</year><volume>50</volume><fpage>364</fpage><lpage>367</lpage><pub-id pub-id-type="pmid">19223404</pub-id></element-citation></ref><ref id="B30"><label>30</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sethi</surname><given-names>D</given-names></name><name><surname>Sen</surname><given-names>R</given-names></name><name><surname>Parshad</surname><given-names>S</given-names></name><name><surname>Khetarpal</surname><given-names>S</given-names></name><name><surname>Garg</surname><given-names>M</given-names></name><name><surname>Sen</surname><given-names>J</given-names></name></person-group><article-title>Histopathologic changes following neoadjuvant chemotherapy in various malignancies</article-title><source>Int J Appl Basic Med Res</source><year>2012</year><volume>2</volume><fpage>111</fpage><lpage>116</lpage><pub-id pub-id-type="pmid">23776823</pub-id></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/LymphedemaV1/Data/Pmc/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 004074 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd -nk 004074 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Sante
|area= LymphedemaV1
|flux= Pmc
|étape= Corpus
|type= RBID
|clé=
|texte=
}}
| This area was generated with Dilib version V0.6.31. |  |