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Pathologic Protocols for Sentinel Lymph Nodes Ultrastaging in Cervical Cancer
Pavel Dundr1, David Cibula1, Kristýna Němejcová1
1From Institute of Pathology (Drs Dundr, Němejcová, Tichá, Bártů, and Jakša) and Gynecologic Oncology Center, Department of Obstetrics and Gynecology (Dr Cibula), First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic.
Pathologic ultrastaging of sentinel lymph nodes (SLNs) lacks a standardized protocol. Significant variations in SLN processing methods can affect cancer detection and patient treatment, necessitating urgent international consensus.
Area of Science:
- Oncology
- Pathology
- Surgical Oncology
Background:
- Sentinel lymph node (SLN) ultrastaging is critical for accurate cancer staging.
- Current international guidelines lack a standardized protocol for SLN ultrastaging.
- Variations in SLN processing can impact patient management and outcomes.
Purpose of the Study:
- To review SLN ultrastaging protocols in cervical cancer patients.
- To identify and analyze discrepancies in SLN processing methods.
- To highlight the need for a standardized international protocol.
Main Methods:
- Systematic literature review of 127 publications (9085 cases).
- Analysis of reported SLN processing techniques, including grossing, slicing, and sectioning.
- Evaluation of protocol variations across studies and institutions.
Main Results:
- Significant heterogeneity exists in SLN processing protocols.
- In 24% of studies, SLN processing details were missing; 7% used no ultrastaging protocol.
- Variations noted in slice thickness, sectioning levels, and section density.
Conclusions:
- Discrepancies in SLN ultrastaging protocols can compromise micrometastasis detection.
- Inconsistent protocols may lead to incorrect adjuvant radiotherapy referrals and treatment failure.
- An international consensus on SLN pathologic ultrastaging is urgently needed for routine clinical practice.
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