SLNs were significantly more likely to contain metastatic disease than non-SLNs (20/376 (5.3%) vs. ![]() Table 3 presents the SLN mapping sensitivity and NPV besides accuracy results for FDG-PET/CT in women with tumors >20 mm. This woman also had clinically suspicious lymph nodes removed per protocol, which were negative of metastatic disease. She did not have a previous cone biopsy, and the SLN mapping procedure was well described with clearly defined SLNs bilaterally. This woman was young, had a normal BMI, and a tumor size >30 mm with a depth of invasion of 19 mm. This corresponds to a false-negative rate of 3.7% (1/27) (95% CI 0.1–19.0%) of the SLN mapping procedure. One woman had bilateral negative SLNs and nodal metastasis in an FDG-PET/CT positive lymph node in the right hemipelvis. The SLN algorithm identified six of seven women with metastatic nodes in ‘non-SLNs only’ due to failed uni- or bilateral SLN detection: five by pelvic lymphadenectomy and one in a clinically suspicious lymph node. Five women had nodal metastasis size over the 75th percentile of 5 mm. The median size of metastasis was 3 mm (range 0.5–11.0). Of the 103 women included in this analysis, 93/103 (90.3%) had FIGO stage IB1 disease, and 10/103 (9.7%) had stage IB2. Reasons for not performing completion PL were comorbidities and tumor size 21–22 mm ( n = 5) and presence of intermediate-risk factors with referral to adjuvant therapy ( n = 3). The remaining eight women were not included since they did not have completion PL performed. There were 22 women with preoperative tumors ≤20 mm and >20 mm on final pathology 14 underwent a second staging procedure with PL and were included in this analysis. Two of the nodal metastases detected by ultrastaging alone were MAC.Ī total of 103 women with a median tumor size of 28.0 mm (range 21.0–63.0) were included in this analysis ( Fig. Ultrastaging alone detected 7/20 (35.0%) of the metastatic SLNs. In all eight women, the nodal metastases were identified in the detected SLN or by contralateral hemilymphadenectomy. Of the 115 women with tumors >20 mm, eight women with nodal metastases had unilateral SLN detection. Finally, in one woman, there was a false-negative SLN, and the metastatic non-SLN was identified in an FDG-PET/CT positive lymph node. In these 11 women with metastatic non-SLNs, six were detected by the SLN algorithm, and four were identified in the parametrium, detected by the radical hysterectomy procedure. In women with nodal metastases and tumors >20 mm, 20/31 (64.5%) were SLNs, and 11/31 (35.5) were in non-SLNs. The proportion, distribution, and mode of detecting metastatic SLNs and non-SLNs are given in Table 2. Lymph node metastases were verified in 38/245 (15.5%) of the women. According to national guidelines, women with high- or combined intermediate-risk factors on final pathology were allocated to postoperative chemo- and radiotherapy [ As per protocol, we decided only to report the largest metastasis per woman. ![]() Non-SLNs were stained with routine HE-staining only. Macrometastasis (MAC) was defined as nodal metastasis ≥2.0 mm, micrometastasis (MIC) as 0.2 to <2.0 mm and isolated tumor cells (ITC) <0.2 mm. The first section at each level was stained with routine hematoxylin and eosin (HE) staining, the second section was used for immunohistochemical staining for cytokeratin AE1/AE3, and the third section was available for additional analysis. At each level, we obtained three consecutive sections, five μm thick. Each 2 mm gross section was cut into four microscopic levels, each obtained at 350 μm intervals. The pathologist gross sectioned the SLNs at 2 mm intervals perpendicular to the long axis. All removed SLNs were fixed in formalin after excision.
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