SLNB Flashcards
When is SLNB most effective?
For tumours less than 2cm in size.
What is the benefit of identification of positive nodes pre-operatively?
Would identify the selection of women that would benefit from primary chemo-radiotherapy and can spare these women the additional morbidity associated with rad hyst and pelvic lymphadenectomy.
What is the NPV of an uninvolved sentinel node?
95%
What is the most reliable method for detection of SLN?
What bilateral detection rates can you achieve?
Combined use of Technetium-99m colloid (99mTc) lymphoscintigraphy and blue dye currently appears
to be the most reliable detection method for SLNB.
92-97% when used together
What is a newer alternative for SLN detection?
Near infrared fluorescence imaging (NIR) with the use of indocyanine green (ICG)
What are the contraindications for ICG
iodine hypersensitivity
Renal failure
pregnancy
breast feeding
What happens if you are unable to locate a SLN on one side?
They require a full lymphadenectomy in that hemi-pelvis
How should SLNB be processed?
SLNs should be processed by serial sectioning and immunohistochemistry. Multiple studies
have found that intra-operative frozen section is limited in its ability to identify small metastases and
micro-metastatic disease
How should SLNB be used clinically
First they have the SLNB - then await histology (as intra-op not sensitive in normal sized LN). Then definitive surgery at a later date if negative.
If a unit does SLNB - what should the women be told?
The women should be advised that the long-term survival outcomes following SLNB alone are not available.
What trial and when shall we expect five year SLNB alone in negative SLN results?
SENTIX study
end of 2021
Can we use SLNB in the management of women with cervical cancer?
it can be considered for tumours less than 2cm in diameter in addition to formal PLND
What happens if you see a large or suspicious LN at the time of SLN mapping?
must be removed
What should we include on the specimen request form?
cervical screening history
results of previous biopsies
dimensions of the cancer, radiology results and details of all specimens sent.
