AIM: The aim of this study was to assess whether the use of sentinel lymph node (SLN) in addition to lymphadenectomy was associated with survival benefit in patients with early-stage cervical cancer. METHODS: International, multicenter, retrospective study. INCLUSION CRITERIA: cervical cancer treated between 01/2007 and 12/2016 by surgery only; squamous cell carcinoma, adenocarcinoma, adenosquamous carcinoma, FIGO 2009 stage IB1-IIA2, negative surgical margins, and laparotomy approach. Patients undergoing neo-adjuvant and/or adjuvant treatment and/or with positive para-aortic lymph nodes, were excluded. Women with positive pelvic nodes who refused adjuvant treatment, were included. Lymph node assessment was performed by SLN (with ultrastaging protocol) plus pelvic lymphadenectomy ('SLN' group) or pelvic lymphadenectomy alone ('non-SLN' group). RESULTS: 1083 patients were included: 300 (27.7 %) in SLN and 783 (72.3 %) in non-SLN group. 77 (7.1 %) patients had recurrence (N = 11, 3.7 % SLN versus N = 66, 8.4 % non-SLN, p = 0.005) and 34 (3.1 %) (N = 4, 1.3 % SLN versus N = 30, 3.8 % non-SLN, p = 0.033) died. SLN group had better 5-year disease-free survival (DFS) (96.0 %,95 %CI:93.5-98.5 versus 92.0 %,95 %CI:90.0-94.0; p = 0.024). No 5-year overall survival (OS) difference was shown (98.4 %,95 %CI:96.8-99.9 versus 96.8 %,95 %CI:95.4-98.2; p = 0.160). SLN biopsy and lower stage were independent factors associated with improved DFS (HR:0.505,95 %CI:0.266-0.959, p = 0.037 and HR:2.703,95 %CI:1.389-5.261, p = 0.003, respectively). Incidence of pelvic central recurrences was higher in the non-SLN group (1.7 % versus 4.5 %, p = 0.039). CONCLUSION: Adding SLN biopsy to pelvic lymphadenectomy was associated with lower recurrence and death rate and improved 5-year DFS. This might be explained by the lower rate of missed nodal metastasis thanks to the use of SLN ultrastaging. SLN biopsy should be recommended in patients with early-stage cervical cancer.

• MeSH
• biopsie sentinelové lymfatické uzliny metody   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymfadenektomie * metody   MeSH
• lymfatické metastázy MeSH
• nádory děložního čípku * patologie   chirurgie   mortalita   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• sentinelová uzlina * patologie   chirurgie   MeSH
• spinocelulární karcinom chirurgie   patologie   mortalita   MeSH
• staging nádorů MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

OBJECTIVE: Management of endometrial cancer is advancing, with accurate staging crucial for guiding treatment decisions. Understanding sentinel lymph node (SLN) involvement rates across molecular subgroups is essential. To evaluate SLN involvement in early-stage (International Federation of Gynecology and Obstetrics 2009 I-II) endometrial cancer, considering molecular subtypes and new European Society of Gynaecological Oncology (ESGO) risk classification. METHODS: The SENECA study retrospectively reviewed data from 2139 women with stage I-II endometrial cancer across 66 centers in 16 countries. Patients underwent surgery with SLN assessment following ESGO guidelines between January 2021 and December 2022. Molecular analysis was performed on pre-operative biopsies or hysterectomy specimens. RESULTS: Among the 2139 patients, the molecular subgroups were as follows: 272 (12.7%) p53 abnormal (p53abn, 1191 (55.7%) non-specific molecular profile (NSMP), 581 (27.2%) mismatch repair deficient (MMRd), 95 (4.4%) POLE mutated (POLE-mut). Tracer diffusion was detected in, at least one side, in 97.2% of the cases; with a bilateral diffusion observed in 82.7% of the cases. By ultrastaging (90.7% of the cases) or one-step nucleic acid amplification (198 (9.3%) of the cases), 205 patients were identified with affected sentinel lymph nodes, representing 9.6% of the sample. Of these, 139 (67.8%) had low-volume metastases (including micrometastases, 42.9%; and isolated tumor cells, 24.9%) while 66 (32.2%) had macrometastases. Significant differences in SLN involvement were observed between molecular subtypes, with p53abn and MMRd groups having the highest rates (12.50% and 12.40%, respectively) compared with NSMP (7.80%) and POLE-mut (6.30%), (p=0.004); (p53abn, OR=1.69 (95% CI 1.11 to 2.56), p=0.014; MMRd, OR=1.67 (95% CI 1.21 to 2.31), p=0.002). Differences were also noted among ESGO risk groups (2.84% for low-risk patients, 6.62% for intermediate-risk patients, 21.63% for high-intermediate risk patients, and 22.51% for high-risk patients; p<0.001). CONCLUSIONS: Our study reveals significant differences in SLN involvement among patients with early-stage endometrial cancer based on molecular subtypes. This underscores the importance of considering molecular characteristics for accurate staging and optimal management decisions.

• MeSH
• biopsie sentinelové lymfatické uzliny metody   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymfatické metastázy MeSH
• nádory endometria * patologie   genetika   klasifikace   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• sentinelová uzlina patologie   MeSH
• staging nádorů * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

OBJECTIVE: To report the outcome of SLN staging in the SENTIX international prospective trial of SLN biopsy in patients with cervical cancer with an intensive ultrastaging protocol and central quality control and to evaluate how the intensity of pathological assessment correlates with metastatic detection rate in SLNs. METHODS: Eligible were patients with stages T1a1/LVSI+ to T1b2 (<4 cm, ≤2 cm for fertility sparing), common tumor types, no suspicious lymph nodes on imaging, and bilateral SLN detection. SLNs were examined intraoperatively and processed by an intensive protocol for ultrastaging (paraffin blocks sectioned completely in 150-μm intervals/levels). SLNs from each site were submitted for central quality control. RESULTS: In the SENTIX SLN study, 647 out of 733 enrolled patients underwent SLN ultrastaging, identifying 12.5% (81/647) with node positive, N1 cases. Intraoperative detection revealed metastases in 56.8% (46/81) of these cases, categorized into macrometastases (83.7%), micrometastases (26.3%), and isolated tumor cells (9.1%). Ultrastaging identified additional metastatic involvement in 43.2% (35/81) of patients, with detailed sectioning revealing metastases (MAC/MIC) at first level in 20 cases (24.7%), at levels 2-4 in 9 cases (11.1%), and at level ≥5 in 6 cases (7.4%). CONCLUSION: SLN ultrastaging detects additional 43% of N1 (MAC/MIC) in patients with negative LNs by imaging and intraoperative pathological assessment. The detection rate of positive SLN correlates with the intensity (number of levels) of ultrastaging. Examination of four levels from paraffin blocks, which detects >90% of patients with N1, is a reasonable compromise for an international standard for ultrastaging. STUDY REGISTRATION: NCT02494063 (ClinicalTrials.gov).

• MeSH
• biopsie sentinelové lymfatické uzliny * metody   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymfatické metastázy * MeSH
• nádory děložního čípku * patologie   chirurgie   MeSH
• prospektivní studie MeSH
• senioři MeSH
• sentinelová uzlina * patologie   chirurgie   MeSH
• staging nádorů * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

OBJECTIVE: The purpose of this study was to establish a consensus on the surgical technique for sentinel lymph node (SLN) dissection in cervical cancer. METHODS: A 26 question survey was emailed to international expert gynecological oncology surgeons. A two-step modified Delphi method was used to establish consensus. After a first round of online survey, the questions were amended and a second round, along with semistructured interviews was performed. Consensus was defined using a 70% cut-off for agreement. RESULTS: Twenty-five of 38 (65.8%) experts responded to the first and second rounds of the online survey. Agreement ≥70% was reached for 13 (50.0%) questions in the first round and for 15 (57.7%) in the final round. Consensus agreement identified 15 recommended, three optional, and five not recommended steps. Experts agreed on the following recommended procedures: use of indocyanine green as a tracer; superficial (with or without deep) injection at 3 and 9 o'clock; injection at the margins of uninvolved mucosa avoiding vaginal fornices; grasping the cervix with forceps only in part of the cervix is free of tumor; use of a minimally invasive approach for SLN biopsy in the case of simple trachelectomy/conization; identification of the ureter, obliterated umbilical artery, and external iliac vessels before SLN excision; commencing the dissection at the level of the uterine artery and continuing laterally; and completing dissection in one hemi-pelvis before proceeding to the contralateral side. Consensus was also reached in recommending against injection at 6 and 12 o'clock, and injection directly into the tumor in cases of the tumor completely replacing the cervix; against removal of nodes through port without protective maneuvers; absence of an ultrastaging protocol; and against modifying tracer concentration at the time of re-injection after mapping failure. CONCLUSION: Recommended, optional, and not recommended steps of SLN dissection in cervical cancer have been identified based on consensus among international experts. These represent a surgical guide that may be used by surgeons in clinical trials and for quality assurance in routine practice.

• MeSH
• biopsie sentinelové lymfatické uzliny metody   MeSH
• indokyanová zeleň MeSH
• konsensus MeSH
• lidé MeSH
• lymfadenektomie metody   MeSH
• lymfatické metastázy patologie   MeSH
• lymfatické uzliny patologie   MeSH
• nádory děložního čípku * chirurgie   patologie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• biopsie sentinelové lymfatické uzliny * metody   MeSH
• klinická studie jako téma MeSH
• lidé MeSH
• lymfadenektomie metody   MeSH
• nádory děložního čípku * chirurgie   diagnóza   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• novinové články MeSH

• Klíčová slova
• SCOUT,
• MeSH
• biopsie sentinelové lymfatické uzliny metody   MeSH
• diagnostické zobrazování metody   MeSH
• kohortové studie MeSH
• lidé MeSH
• lymfadenektomie metody   MeSH
• mamografie MeSH
• mastektomie metody   MeSH
• metastázy nádorů diagnostické zobrazování   terapie   MeSH
• nádory prsu * chirurgie   diagnostické zobrazování   MeSH
• nerandomizované kontrolované studie jako téma MeSH
• prospektivní studie MeSH
• prsy diagnostické zobrazování   patologie   MeSH
• radar MeSH
• stupeň nádoru metody   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH

• MeSH
• biopsie sentinelové lymfatické uzliny metody   MeSH
• lidé MeSH
• lymfadenektomie metody   MeSH
• mamoplastika metody   MeSH
• mastektomie metody   MeSH
• triple-negativní karcinom prsu * chirurgie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• přehledy MeSH

The aim of the study was to map the lymphatic drainage of the upper extremity that traverses the axilla and elucidate its relationship with the lymphatic drainage of the breast. In 79 breast cancer patients indicated to the axillary lymph node dissection for category cN1, cN2, Technetium-99m (particle size <80 nm) was applied prior to surgery at two injection sites between the second and third metacarpophalangeal joints to visualize upper extremity lymphatics. During the surgery, the axilla was anatomically divided into 6 quadrants. A C-Trak® device was used for the intraoperative detection of radioactivity. After verifying activity, the nodes were resected and their position was recorded. Active nodes were sent separately according to topographic localizations for microscopic examination. All affected nodes (both macro- and micrometastases) were recorded as positive. The location, involvement and radioactivity, and the number of lymph nodes obtained were analyzed. In total, 1,109 lymph nodes were removed and examined. Radioactive nodes were found in all 79 patients. A total of 230 radioactive nodes were found. 21 nodes were both radioactive and metastatically affected. Results show that part of the lymph from the upper extremity flows through the nodes in the central part of the axilla and mixes with the lymph from the breast. This suggests that lymphatic drainage of the upper limb cannot be functionally separated from lymphatic drainage of the breast. The results also explain the possible mechanical cause of arm lymphedema after sentinel lymph node biopsy.

• MeSH
• axila patologie   MeSH
• biopsie sentinelové lymfatické uzliny škodlivé účinky   metody   MeSH
• lidé MeSH
• lymfadenektomie škodlivé účinky   MeSH
• lymfatické uzliny patologie   chirurgie   MeSH
• lymfedém * etiologie   patologie   chirurgie   MeSH
• mastektomie škodlivé účinky   MeSH
• nádory prsu * patologie   chirurgie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Úvod: Role chirurgické biopsie sentinelové uzliny (SLNB) u pacientek s karcinomem prsu po neoadjuvantní chemoterapii (NAC) je v současné době předmětem diskuzí. Cílem naší práce bylo zjistit falešnou negativitu (FNR) SLNB, přesnost ultrazvukového vyšetření při hodnocení stavu lymfatických uzlin a přesnost peroperační kryobiopsie sentinelové uzliny (SLN). Metody: Prospektivní multicentrická studie, která probíhala v letech 2018−2020 na třech pracovištích v ČR. Celkem bylo hodnoceno 59 pacientek. Výsledky: Falešná negativita SLNB u skupiny pacientek cN1 před NAC a ycN0 po NAC byla 12,5 %. FNR peroperačního histologického vyšetření SLN byla 38,5 %. FNR ultrazvukového vyšetření axilárních lymfatických uzlin u pacientek po NAC byla 35,5 %, falešná pozitivita byla 16,7 %. Incidence zánětlivých komplikací v našem souboru byla 3,3 %. Závěr: Falešná negativita SLNB u skupiny pacientek cN1 před NAC a ycN0 po NAC přesahuje tolerovatelnou hranici 10 %. FNR peroperačního histologického vyšetření SLN je vysoká, definitivní histologické vyšetření SLN může změnit původní diagnosticko-terapeutický plán. Ultrazvukové vyšetření axilárních lymfatických uzlin je u pacientek po NAC metoda s vysokou falešnou negativitou i pozitivitou, a nemusí tedy korespondovat s peroperačním nálezem. Incidence zánětlivých komplikací v našem souboru u pacientek po NAC je srovnatelná s literárními údaji o četnosti komplikací pacientek bez NAC.

Introduction: The role of sentinel lymph node biopsy (SLNB) in patients with breast cancer after neoadjuvant chemotherapy (NAC) is currently under discussion. The aim of our study was to determine the false negativity rate (FNR) of SLNB, the accuracy of ultrasound examination in the evaluation of the status of lymph nodes and the accuracy of perioperative cryobiopsy of the sentinel lymph node (SLN). Methods: Prospective multicentre study, which took place in years 2018−2020 at three centres in the Czech Republic. A total of 59 patients were evaluated. Results: The FNR of SLNB in the group of patients with cN1 before NAC and ycN0 after NAC was 12.5%. The FNR of perioperative histological examination of the SLN was 38.5%. The FNR of ultrasound examination of axillary lymph nodes in patients after NAC was 35.5%, and the false positivity rate was 16.7%. The incidence of inflammatory complications in our cohort was 3.3%. Conclusion: The FNR of SLNB in the group of patients with cN1 before NAC and ycN0 after NAC exceeds the tolerable limit of 10%. The FNR of perioperative histological examination of the SLN is high; definitive histological examination of the SLN may change the original diagnostic-therapeutic plan. Ultrasound examination of the axillary lymph nodes in patients after NAC is a method with high false negativity and positivity and may not correspond with the perioperative finding. The incidence of inflammatory complications in our cohort in patients after NAC is comparable to literature data on the frequency of complications in patients without NAC.

• Klíčová slova
• axilární disekce,
• MeSH
• biopsie sentinelové lymfatické uzliny * metody   MeSH
• lidé MeSH
• multicentrické studie jako téma MeSH
• nádory prsu * chirurgie   diagnóza   farmakoterapie   MeSH
• neoadjuvantní terapie MeSH
• prediktivní hodnota testů MeSH
• prospektivní studie MeSH
• reprodukovatelnost výsledků MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

INTRODUCTION: Sentinel lymph node dissection is widely used in the staging of endometrial cancer. Variation in surgical techniques potentially impacts diagnostic accuracy and oncologic outcomes, and poses barriers to the comparison of outcomes across institutions or clinical trial sites. Standardization of surgical technique and surgical quality assessment tools are critical to the conduct of clinical trials. By identifying mandatory and prohibited steps of sentinel lymph node (SLN) dissection in endometrial cancer, the purpose of this study was to develop and validate a competency assessment tool for use in surgical quality assurance. METHODS: A Delphi methodology was applied, included 35 expert gynecological oncology surgeons from 16 countries. Interviews identified key steps and tasks which were rated mandatory, optional, or prohibited using questionnaires. Using the surgical steps for which consensus was achieved, a competency assessment tool was developed and subjected to assessments of validity and reliability. RESULTS: Seventy percent consensus agreement standardized the specific mandatory, optional, and prohibited steps of SLN dissection for endometrial cancer and informed the development of a competency assessment tool. Consensus agreement identified 21 mandatory and three prohibited steps to complete a SLN dissection. The competency assessment tool was used to rate surgical quality in three preselected videos, demonstrating clear separation in the rating of the skill level displayed with mean skills summary scores differing significantly between the three videos (F score=89.4; P<0.001). Internal consistency of the items was high (Cronbach α=0.88). CONCLUSION: Specific mandatory and prohibited steps of SLN dissection in endometrial cancer have been identified and validated based on consensus among a large number of international experts. A competency assessment tool is now available and can be used for surgeon selection in clinical trials and for ongoing, prospective quality assurance in routine clinical care.

• MeSH
• biopsie sentinelové lymfatické uzliny metody   normy   MeSH
• delfská metoda MeSH
• dospělí MeSH
• gynekologie metody   MeSH
• klinické kompetence MeSH
• konsensus MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony metody   MeSH
• nádory endometria chirurgie   MeSH
• průzkumy a dotazníky MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH