Sentinel lymph node mapping in early-stage cervical cancer: Results from the SENTIX prospective multicenter study

Objective

To assess sentinel lymph node (SLN) bilateral detection rate, anatomical distribution, and tracer performance in early-stage cervical cancer patients undergoing primary surgery, based on data from the prospective multicenter SENTIX trial.

Methods

Patients with FIGO 2018 stage IA1 (LVSI+) to IB2 cervical cancer and no suspicious lymph nodes on preoperative imaging were enrolled in the SENTIX trial. SLN biopsy was performed using blue dye (BD), radiocolloid (RC), indocyanine green (ICG), or their combinations. Only patients with successful bilateral SLN detection and negative intraoperative frozen section proceeded to radical hysterectomy or fertility-sparing surgery. SLN locations and metastatic status were documented by anatomical region and centrally reviewed for consistency.

Results

Among 724 patients who underwent SLN biopsy, the overall bilateral detection rate was 92.3 %, with the highest rate (100 %) achieved using ICG and RC combination. If mapping-failure cases were considered, the bilateral detection rate would be 84.6 %. Most SLNs (91.6 %) were located at pelvic level I, predominantly in the external iliac and interiliac regions. SLNs above the interiliac bifurcation were infrequent (2.7 %), and isolated positive SLNs in pelvic level II were rare (1.3 %). No SLNs were identified in paraaortic regions. Bilateral detection was unaffected by BMI, histology, or prior conization. Although detection was slightly lower in tumors >2 cm, bilateral rates exceeded 90 %.

Conclusions

SLN mapping demonstrated high bilateral detection across tracers and patient subgroups. Nearly all SLNs were confined to pelvic level I, underscoring anatomical predictability. These results demonstrate reproducible SLN mapping in tumors ≤4 cm and may help inform individualized surgical planning.