SUNNYBROOK HEALTH SCIENCES CENTRE

SUNNYBROOK HEALTH SCIENCES CENTRE

January 29, 2010 11:04 ET

FIRST REPORT THAT LESSER USED BIOPSY TELLS MORE

Sentinel Lymph Node biopsy less commonly used in cervical cancer, yields three fold higher lymph node metastases detection over standard method, and offers proven reduced complications for patients.

Attention: Assignment Editor, Health/Medical Editor, Lifestyle Editor, News Editor, Science Editor TORONTO, ONTARIO, NEWS RELEASE--(Marketwire - Jan. 29, 2010) - For the first time ever reported in cervical cancer, Sunnybrook researchers have shown higher detection of lymph node metastases, one of the most telling factors about the course of disease, using Sentinel Lymph Node biopsy compared to complete pelvic lymphadenectomy, in a study published in Gynecologic Oncology.

"These findings inform a newer way of thinking about the management of cervical cancer," says Dr. Allan Covens, surgical oncologist and head, Gynecology Cancer Care Team, Sunnybrook's Odette Cancer Centre. "In our view, complete lymphadenectomy as a gold standard for lymph node assessment in cervical cancer is cogently challenged. More frequent use of Sentinel Lymph Node biopsy in cervical cancer detects more lymph node metastases, which may have a positive overall impact on survival."

Sentinel Lymph Node biopsy reduces a patient's complications such as pain and lymphedema (chronic swelling) of limbs and or soft tissue, and is used widely in melanoma, breast and vulva cancers. Sentinel Lymph Node biopsy removes one to two sentinel lymph nodes (the first lymph nodes to drain from the primary tumour, hence the first to harbour metastases) compared to pelvic lymphadenectomy involving the removal of ten to 30 lymph nodes, and increased complications.

"Our findings of higher lymph node metastases (including micrometastases) detection using Sentinel Lymph Node biopsy together with known reduced complications for patients and low false-negative rates, suggest a strong efficacy advantage of this procedure over the standard complete pelvic lymphadenectomy procedure in early stage cervical cancer," says Dr. Covens, Professor, Obstetrics and Gynecology, and director Gynecologic Oncology Fellowship, University of Toronto.

Findings indicate a lymph node metastases detection rate almost 3 fold higher with Sentinel Lymph Node biopsy compared to pelvic lymphadenectomy. All sentinel lymph node metastases were smaller than one centimetre. The higher detection rate the researchers suggest may be due to the extensive sectioning performed on Sentinel Lymph Node biopsy. Another possible explanation may be related to the unusual locations of sentinel lymph nodes in cervical cancer. Over 21 per cent of the cohort of 87 patients who underwent Sentinel Lymph Node biopsy, had sentinel lymph nodes located either in the common iliacs or paraaortics. These nodes would not be typically removed in a standard pelvic lymphadenectomy.

The researchers compared 81 of the 87 patients who underwent Sentinel Lymph Node biopsy, to 218 matched patients who had complete pelvic lymphadenectomy. Both groups subsequently underwent radical hysterectomy or radical trachelectomy.

Despite continued yearly declines in mortality rates for cervical cancer, in 2009 an estimated 1,300 Canadian women were diagnosed with cervical cancer and an estimated 380 women died from the disease.
/For further information: www.sunnybrook.ca/ IN: HEALTH

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