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Silva, Lucas B.; Traima, Paulo; Melo, José Renan C.; Triginelli, Sérgio A.; Barroso, Adelanir A.; Lima, Carla F. ; Siqueira, Cristiano F.; Pedrosa, Moises S. ; Rossi, Telma F.
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Nuclear MedCenter; Fundação Mário Penna; Ecograf; Hospital das Clínicas - UFMG
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Correspondencia:
Adelanir A. Barroso
E-mail: adelanir@sbbmn.com.br
Fono: 32-3275-3534
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Cita/Reference:
Silva, Lucas B.; Traima, Paulo; Melo, José Renan C. et al. Lymphatic Mapping and Sentinel Node Detection using 99mTc-Phytate in Cervix Cancer - 55 cases. Alasbimn Journal 7(27): January 2005
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Lymphatic Mapping and Sentinel Node Detection using 99mTc-Phytate in Cervix Cancer - 55 cases
AIMS: To demonstrate a multicentric experience of a brazilian capital in the validation of sentinel lymph node biopsy (SLNB) for cervix cancer, comparing with data from radical lymphadenectomy. To assess the accuracy of SLNB by a radioisotopic technique, with or without the use of Blue Patent (BP).
METHODS: Fifty-five women, average age of 48.6, ranging from 24 to 73 years old, were studied. Of these, 48 had positive diagnosis of squamous cell carcinoma; 8 of invasive adenocarcinoma; and 1 of undifferentiated carcinoma. A number of 51 were in stage I and 4 in stage II. The patients, were divided into two groups: Group I, including 20 patients, using PB and gamma-probe (GP); and Group II, with 35 patients, only using GP. 99mTc-Phytate (IPEN, São Paulo, Brazil) was administered into four cardinal points in the uterine cervix (0.2 ml / point) at the dose of 0.8-1 mCi, calculated for the day of the surgery. As for BP, a volume of 0.5 ml was injected into each point. Lymphoscintigraphy images were obtained at least 2 hours after injection of the radiotracer (RT), on both anterior and lateral projections, identifying sentinel lymph nodes under the skin.
RESULTS: Out of the 55 patients, sentinel lymph node was seen in 72.28% (51) of them and 7.28% (4) patients showed no RT uptake. There was bilateral RT uptake in 41% of the cases and unilateral uptake in 59%. The sensitivity of SLNB to predict the status of the lymphatic bed was 94.54% (52), detecting metastatic disease in 30.9% (17) of the cases, from which 41% (7) had metastasis only in the sentinel lymph nodes. False positive rate achieved 5.8% (3), in whom lymph nodes involved by parametrial lesions were not detected. Isolated RT technique identified lesions in 51/55 patients (Sensib. of 92.72%); the PB technique, a number of 13/20 (Sensib. of 65%); and, when GP and PB were associated, the lesions could be detected in 52/55 cases (Sensib. of 94.54%) .
CONCLUSIONS: SLNB using 99mTc-Phytate in cervical cancer patients is possible, efficient, and has a great negative predictive value. Potentially, the method allows identification of patients for whom radical lymphadenectomy may be prevented. Association of radioguided surgery and Patent Blue enhances sensitivity of sentinel lymph node detection, with a high accuracy to predict the status of lymphatic bed: 94% of the patients analyzed in the present investigation. Such technique is a promising tool for diminishing morbidity of gynecologic cancer.
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