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Sentinel lymph node pathological ultrastaging: Final outcome of the Sentix prospective international study in patients with early-stage cervical cancer
R. Kocian, C. Kohler, S. Bajsova, J. Jarkovsky, I. Zapardiel, G. Di Martino, L. van Lonkhuijzen, B. Sehnal, OA. Sanchez, B. Gil-Ibanez, F. Martinelli, J. Presl, L. Minar, R. Pilka, P. Kascak, P. Havelka, M. Michal, T. van Gorp, K. Nemejcova, P....
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články, multicentrická studie
- 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: 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).
Center for Gynecologic Oncology Academic Medical Centre Amsterdam Netherlands
Department of Gynecological Oncology Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Italy
Department of Gynecology and Obstetrics Faculty of Medicine Masaryk University Brno Czech Republic
Department of Obstetrics and Gynecology Faculty Hospital Trencin Trencin Slovakia
Department of Obstetrics and Gynecology KNTB a s Zlin Czech Republic
Department of Obstetrics and Gynecology La Paz University Hospital Madrid Spain
Department of Obstetrics and Gynecology University Hospital Ostrava Ostrava Poruba Czech Republic
Department of Special Operative and Oncologic Gynaecology Asklepios Clinic Hamburg Hamburg Germany
Gynecologic Oncology Surgical Division Humanitas San Pio 10 Milan 20159 Italy
Gynecology Unit IRCCS Fondazione San Gerardo dei Tintori 20900 Monza Italy
Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czech Republic
Citace poskytuje Crossref.org
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- $a Kocian, Roman $u Gynecologic Oncology Center, Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic. Electronic address: Roman.Kocian@vfn.cz
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