Para-Aortic Lymph Node Metastasis Detected by Sentinel Lymph Node Biopsy in Cervical Cancer Initially Presumed to be...

Sentinel node navigation surgery (SNNS) minimizes unnecessary lymphadenectomy and its associated complications while enhancing detection of lymph node micrometastases through ultrastaging. A 34-year-old nulligravid woman with a history of CIN2 was diagnosed with squamous cell carcinoma (4.5 mm width, 4 mm depth) with lymphovascular invasion after conization. Clinical stage was T1a2 (FIGO 2018). Modified-radical trachelectomy with SNNS was planned for fertility preservation. SPECT-CT identified bilateral obturator and left lower para-aortic sentinel nodes. Intraoperative frozen sections revealed a 1.1 mm micrometastasis in the left obturator node and a 2.5 mm macrometastasis in the left para-aortic node. The procedure was converted to modified-radical hysterectomy with bilateral adnexectomy and pelvic lymphadenectomy, followed by concurrent chemoradiotherapy including the para-aortic field. The patient remains disease-free at 10 months. Without SNNS, the para-aortic metastasis would have been undetected, resulting in inadequate radiation coverage. SNNS fundamentally changes therapeutic approaches by enabling accurate disease extent identification and individualized treatment.