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.

Breast Gynaecology and Reconstructive Surgery Unit Institute Curie Paris France

Centre Hospitalier Universitaire Vaudois Departement de gynecologie obstetrique et genetique medicale Lausanne Switzerland

Department of Academic Analytics and Technology University of Texas MD Anderson Cancer Center Houston Texas USA

Department of Gynaecology and Obstetrics Ente Ospedaliero Cantonale Lugano Switzerland

Department of Gynaecology Gynaecologic Oncology Clinica Astorga Medellin Colombia

Department of Gynaecology University of Cologne Koln Germany

Department of Gynecologic Oncology and Reproductive Medicine University of Texas MD Anderson Cancer Center Houston Texas USA

Department of Obstetrics and Gynaecology Felix Guyon Hospital CHU Nord Réunion France

Department of Obstetrics and Gynaecology Fribourg Hospitals Fribourg Switzerland

Department of Obstetrics and Gynaecology Medical University of Innsbruck Innsbruck Austria

Department of Obstetrics and Gynecology Charles University 1st Faculty of Medicine Prague Czech Republic

Department of Obstetrics and Gynecology Houston Methodist Hospital Houston Texas USA

Department of Obstetrics and Gynecology Northwestern University Evanston Illinois USA

Department of Special Operative and Oncologic Gynaecology Asklepios Clinic Hamburg Altona Asklepios Hospital Group Hamburg Germany

Department of Surgical Oncology Centre Oscar Lambret Lille France

Department of Surgical Oncology Institut Claudius Regaud Institut Universitaire du Cancer de Toulouse Oncopole Toulouse France

Gynaecologic Oncology Ospedale Michele e Pietro Ferrero Verduno Italy

Gynaecologic Oncology Universidad de Navarra Pamplona Spain

Gynaecology and Gynaecological Oncology Inselspital University Hospital Berne Department of Gynaecology Bern Switzerland

Gynaecology and Obstetrics University of Kinshasa Kinshasa Congo

Gynecologic Oncology Toronto Sunnybrook Regional Cancer Center Toronto Ontario Canada

Gynecologic Oncology Unit La Paz University Hospital Madrid Spain

Gynecology Service Department of Surgery Memorial Sloan Kettering Cancer Center New York New York USA

Instituto Nacional de Cancerología Bogotá Colombia

Laval University Quebec City Quebec Canada

Obstetrics and Gynaecology Derby Hospitals NHS Foundation Trust Derby UK

Obstetrics and Gynaecology National Taiwan University Hospital Hsin Chu Branch Hsinchu Taiwan

Queensland Centre for Gynaecological Cancer Research Faculty of Medicine Centre for Clinical Research The University of Queensland Brisbane Queensland Australia

Università della Svizzera italiana Lugano Switzerland

UOC Ginecologia Oncologica Dipartimento di Scienze della Salute della Donna del Bambino e di Sanità Pubblica Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy

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