Current Cancer Therapy Reviews, 2007, 3, 209-214 209 1573-3947/07 $50.00+.00 © 2007 Bentham Science Publishers Ltd. Sentinel Lymph Node Identification in Patients with Stage IB1 Invasive Cervical Carcinoma Ricardo dos Reis 1,4,* , Eduardo Belmonte Tavares 2 , Beatriz Amaral 5 , Heleusa Ione Monego 4 , Márcia Binda 4 , Valentino Magno 1,4 , Waldemar Rivoire 1,2,4 , Maria Isabel Edelweiss 1,3 and Edison Capp 1,2,4 1 Programa de Pós-Graduação em Medicina: Ciências Médicas, 2 Departamento de Ginecologia e Obstetrícia, 3 Departamento de Patologia Faculdade de Medicina, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Brazil; 4 Setor de Oncologia Genital Feminina, Serviço de Ginecologia e Obstetrícia, Hospital de Clínicas de Porto Alegre, Brazil; 5 Clínica Radimagem, Porto Alegre, Brazil, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350 – CEP 90035-003, Bairro Rio Branco, Porto Alegre, RS, Brazil Abstract: Background and Objectives: To establish the feasibility of sentinel lymph node (SLN) identification in patients with stage IB1 invasive cervical cancer. Methods: Selected patients with cervical cancer scheduled for radical hysterectomy with bilateral pelvic lymphadenectomy underwent SLN detection. Preoperatively, 1 mCi of technetium-99 ( 99 Tc) was in- jected into four points of the superficial cervical stroma around the tumor. Intraoperatively, the patients underwent gamma-probe-guided lymphatic mapping, and patent blue dye was injected into the same points as the 99 Tc. Results: Of the 12 eligible patients, 11 (92%) had at least one SLN detected. Seven (64%) patients had SLNs detected by intraopera- tive lymphoscintigraphy and the blue-dye technique, 3 (27%) by intraoperative lymphoscintigraphy, and 1 (9%) by the blue-dye technique only. Intraoperatively, 22 SLNs were detected: 9 (41%) by lymphoscintigraphy, 7 (32%) by lym- phoscintigraphy and the blue-dye technique, and 6 (27%) by the blue-dye technique only. Six patients (54.5%) had bilat- eral SLNs. Sensitivity, specificity, positive predictive value, and negative predictive value for SLN detection were 100%, 80%, 33%, and 100%, respectively. There were no false-negative results. Conclusions: In this small cohort of patients, the combination of 99 Tc and patent blue dye was safe and feasible for the detection of SLNs in early-stage cervical cancer. This study investigates the sentinel lymph node technique in patients with stage IB1 cervical cancer. Key Words: Sentinel lymph node (SLN), cervical cancer, patent blue dye, technetium. INTRODUCTION Cervical cancer is the most frequently occurring malig- nant tumor of the female genital tract in Brazil and in devel- oping countries. It is estimated that 500,000 new cases of cervical cancer are reported around the world every year, 85% of which are in developing countries, with half of them resulting in death [1]. In Brazil, the incidence ranges from approximately 20/100,000 in the South and Southeast re- gions to 90/100,000 in some areas of the North/Northeast and Central West regions [2]. In the United States, cervical cancer is the third most common gynecological malignancy. In 2006, 9,710 women were diagnosed with cervical carci- noma in the US, and approximately 3,700 died of this dis- ease [3]. Approximately 25% of all patients diagnosed with cervi- cal cancer are candidates for radical hysterectomy with pel- vic lymphadenectomy. Stage IB1 is uncommon as first pres- entation in public institutions in Brazil. Surgical treatment preserves ovarian and sexual function, whereas radiotherapy or chemoradiation not. However, the procedure is associated with significant morbidity such as vascular injuries, lympho- cyst formation, lymphedema, and urologic complications [4]. *Address correspondence to this author at the Hospital de Clinicas de Porto Alegre / Servico de Ginecologia e Obstetrícia, Rua Ramiro Barcelos, 2350, Bairro Rio Branco– CEP 90035-003, Porto Alegre – RS, Brazil; E-mail: dr.ricardoreis@hotmail.com The prevalence of lymph node metastasis is closely corre- lated with the stage of the disease. Because the incidence of metastasis in pelvic lymph nodes in patients with clinical stage IB cervical carcinoma varies from 15 to 20% and the percentage of para-aortic lymph node involvement varies from 0 to 22%, a complete lymphadenectomy may not be necessary in most of these patients [5]. Therefore, it is im- portant to identify patients with lymph node metastases. It is well established that after radical hysterectomy, one of the more common indications for postoperative adjuvant radia- tion therapy is the presence of lymph nodes positive for me- tastatic disease. Cabanas was the first to use the term “sentinel node” [6], which is generally defined as the first lymph node that tumor cells spread to from the primary disease site. Documentation of metastatic disease in the sentinel lymph node could poten- tially spare the patient a complete lymphadenectomy. Senti- nel node identification is well established in breast cancer [7] and melanoma [8]. In 1994, Levenback et al. [9] were the first to introduce the sentinel node technique in gynecologic malignancies. They performed intraoperative lymphatic mapping in vulvar cancer, detecting sentinel nodes with iso- sulfan blue in seven of nine patients. Burke et al. proposed that intraoperative lymphatic mapping of the uterine fundus in high-risk endometrial cancer is feasible and can identify targets for selective nodal biopsy in some women [10].