Usefulness of preoperative lymphoscintigraphy in patients who undergo radical hysterectomy and pelvic lymphadenectomy for cervical cancer

Objective The purpose of this study was to assess the value of preoperative lymphoscintigraphy before intraoperative lymphatic mapping for sentinel lymph node identification during radical hysterectomy. Study design Fifty patients underwent intraoperative lymphatic mapping on our institutional review board–approved protocol. The location of sentinel lymph nodes that were found on lymphoscintigraphy and intraoperative lymphatic mapping were compared. Results Fifteen of 21 patients (71%) with solitary sentinel lymph nodes that were found on lymphoscintigraphy had multiple sentinel lymph node basins found during the operation. Thirteen of 25 patients (52%) with unilateral sentinel lymph node basins that were found on lymphoscintigraphy had bilateral sentinel lymph nodes at intraoperative lymphatic mapping. Of 15 patients with 2 sentinel lymph node locations that were identified on lymphoscintigraphy, 12 patients (80%) had ≥3 found during the operation. Of the sentinel lymph nodes that were located on the external iliac basin (n = 47) on lymphoscintigraphy, only 20 lymph nodes (43%) were found at that location during the operation. Concordance between the 2 methods was poor. Seven of the 9 patients with lymph node metastases had disease that was limited to the sentinel lymph nodes. Conclusion Preoperative lymphoscintigraphy adds little value over intraoperative lymphatic mapping for sentinel lymph node identification during radical hysterectomy.