Laparoscopic Sentinel Node Procedure in Patients With Cervical Cancer
Authors: Emmanuel Barranger, Dany Grahek, Annie Cortez, Serge Uzan, Emile Darai, Charles Levenback, Robert L. Coleman
Journal: Journal of Clinical Oncology (2002)

Article Tools SPECIAL DEPARTMENTS Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2002.20.10.2602 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 12011139 Laparoscopic Sentinel Node Procedure in Patients With Cervical Cancer Emmanuel BarrangerxEmmanuel BarrangerSearch for articles by this author , Dany GrahekxDany GrahekSearch for articles by this author , Annie CortezxAnnie CortezSearch for articles by this author , Serge UzanxSerge UzanSearch for articles by this author , Emile DaraixEmile DaraiSearch for articles by this author Charles LevenbackxCharles LevenbackSearch for articles by this author , Robert L. ColemanxRobert L. ColemanSearch for articles by this author Show More Hôpital Tenon, Paris, FranceUniversity of Texas M.D. Anderson Cancer Center, Houston, TXUniversity of Texas Southwestern Medical Center, Dallas, TX https://doi.org/10.1200/JCO.2002.20.10.2602 First Page Full Text PDF Figures and Tables © 2002 by American Society of Clinical OncologyjcoJ Clin OncolJournal of Clinical OncologyJCO0732-183X1527-7755American Society of Clinical OncologyResponse15052002In Reply:Barranger et al have made some interesting observations regarding our recent report describing combined lymphatic mapping during radical hysterectomy.1 The issue of surgeon experience is important and has been widely discussed in the breast and melanoma literature. The ongoing phase III trials at these disease sites (American College of Surgeons Oncology Group Z-10, National Surgical Adjuvant Breast and Bowel Project B-32, Melanoma Sunbelt Trial, and the Multi-Center Lymphadenectomy Trial) all require surgeon skill verification of up to 30 cases before individual clinicians may participate. This standard is clearly impractical for gynecologic oncologists. Gynecologic Oncology Group Trial 173, a validation trial in vulvar cancer patients, and Gynecologic Oncology Group Trial CVM 0111, a validation trial in radical hysterectomy patients under development, do not have surgeon skill verification requirements. In our study, the two lead authors personally performed 19 (49%) of 39 procedures and assisted with others.It is premature to draw any conclusion about the false-negative rate with mapping in this setting. Our false-negative patient had small positive medial parametrial nodes resected with the primary tumor that are essentially impossible to locate with blue dye or the gamma probe. In addition, the importance to survival of medial parametrial node involvement, in and of itself, has been questioned.2 Our study did not directly compare sentinel node identification rates with blue dye alone to the combined approach. However, the results reported in this study are clearly superior to our previously published results from the University of Texas Southwestern.3The combination of laparoscopy and sentinel node biopsy is very attractive in patients with cervix cancer. Three studies have described laparoscopic identification of sentinel nodes in patients with cervix cancer.4-6 Dargent et al4 reported excellent results with blue dye alone, as did Kamprath et al6 with radiocolloid alone. Malur et al5 described the use of a laparoscopic gamma probe in a small subset of cases.We would like to restate our conviction that there is not sufficient data available to recommend replacement of pelvic lymphadenectomy with sentinel node biopsy alone. Nevertheless, we believe that cervix cancer is an excellent target for the mapping strategy and are very interested by the work of Barranger and his colleagues. We look forward to a more complete description of their series.1. Levenback C, Coleman RL, Burke TW, et al: Lymphatic mapping and sentinel node identification in patients with cervix cancer undergoing radical hysterectomy and pelvic lymphadenectomy. J Clin Oncol 20:: 688,2002-693, Link, Google Scholar2. Winter R, Haas J, Reich O, et al: Parametrial spread of cervical cancer in patients with negative pelvic lymph nodes. Gynecol Oncol 84:: 252,2002-257, Crossref, Medline, Google Scholar3. O’Boyle JD, Coleman RL, Bernstein SG, et al: Intraoperative lymphatic mapping in cervix cancer patients undergoing radical hysterectomy: A pilot study. Gynecol Oncol 79:: 238,2000-243, Crossref, Medline, Google Scholar4. Dargent D, Martin X, Mathevet P: Laparoscopic assessment of the sentinel lymph node in early stage cervical cancer. Gynecol Oncol 79:: 411,2000-415, Crossref, Medline, Google Scholar5. Malur S, Krause N, Kohler C, et al: Sentinel lymph node detection in patients with cervical cancer. Gynecol Oncol 80:: 254,2001-257, Crossref, Medline, Google Scholar6. Kamprath S, Possover M, Schneider A: Laparoscopic sentinel lymph node detection in patients with cervical cancer. Am J Obstet Gynecol 182:: 1648,,2000 (letter) Google Scholar