Our Summary

This research paper looks into the changes over time in how doctors in the US treat cervical cancer. Specifically, the researchers are interested in a surgical procedure called sentinel lymph node biopsy. This is where doctors remove one or a few lymph nodes (small glands that are part of the immune system) to check if the cancer has spread. The idea is to remove the least number of lymph nodes necessary to get accurate information.

The researchers looked at data from the National Cancer Institute on nearly 13,500 patients with early-stage cervical cancer who had surgery to remove the cancer between 2004 and 2021. They found that the use of sentinel lymph node biopsy, either with or without removing additional lymph nodes, increased from 0.2% to 15.1% between 2004 and 2018. After 2018, this rate stabilized.

Interestingly, in 2018, the use of sentinel lymph node biopsy without removing additional lymph nodes became more common than doing the biopsy and removing additional nodes. This change continued, with the use of biopsy alone increasing from 8.8% in 2018 to 11.3% in 2021. By 2021, two-thirds of all sentinel lymph node evaluations were done without removing additional lymph nodes.

The researchers also looked at survival rates and found no significant difference between those who had the biopsy alone and those who had the biopsy with additional nodes removed.

In simple terms, this research suggests that more doctors are choosing to remove fewer lymph nodes when checking for the spread of early-stage cervical cancer, and this approach seems to be just as effective in terms of patient survival.

FAQs

  1. What is the trend in the utilization of sentinel lymph node biopsy in cervical cancer surgeries in the United States?
  2. What did the study find about the survival rates among patients who underwent sentinel lymph node biopsy with or without additional lymphadenectomy?
  3. How has the use of sentinel lymph node biopsy alone, without additional lymphadenectomy, changed between 2018 and 2021?

Doctor’s Tip

A helpful tip a doctor might tell a patient about sentinel lymph node biopsy is to follow post-operative care instructions carefully, including avoiding heavy lifting or strenuous activity for a certain period of time, watching for signs of infection at the biopsy site, and attending follow-up appointments to monitor for any complications or changes in lymph node status. It is also important to discuss any concerns or questions with your healthcare provider.

Suitable For

Patients with American Joint Commission on Cancer T1 classification cervical cancer who undergo anti-cancer surgery either with hysterectomy, trachelectomy, or cervical excision and additional surgical nodal evaluation are typically recommended sentinel lymph node biopsy.

Timeline

Before sentinel lymph node biopsy:

  • Patient is diagnosed with cervical cancer
  • Patient undergoes pre-operative evaluation and staging
  • Patient discusses treatment options with their healthcare team
  • Decision is made to undergo surgery with sentinel lymph node biopsy

After sentinel lymph node biopsy:

  • Patient undergoes surgery (hysterectomy, trachelectomy, or cervical excision) with sentinel lymph node biopsy
  • Sentinel lymph nodes are identified and removed for evaluation
  • Pathology report is reviewed to determine if cancer has spread to the lymph nodes
  • Treatment plan is adjusted based on the results of the sentinel lymph node biopsy
  • Patient may undergo additional treatments such as chemotherapy or radiation therapy
  • Follow-up appointments are scheduled for monitoring and surveillance

Overall, the use of sentinel lymph node biopsy alone without additional lymphadenectomy has increased over time and has been shown to have comparable survival outcomes to concurrent sentinel lymph node biopsy with lymphadenectomy. This suggests that sentinel lymph node biopsy alone may be a viable option for some patients with cervical cancer.

What to Ask Your Doctor

  1. What is a sentinel lymph node biopsy and how is it different from a traditional lymphadenectomy?

  2. What are the benefits of having a sentinel lymph node biopsy alone compared to having additional lymphadenectomy during surgery?

  3. Are there any potential risks or complications associated with sentinel lymph node biopsy alone?

  4. How will the results of the sentinel lymph node biopsy impact my treatment plan and prognosis?

  5. What is the success rate of detecting lymph node involvement with sentinel lymph node biopsy alone?

  6. Will I need any additional follow-up or monitoring after having a sentinel lymph node biopsy alone?

  7. How experienced is the surgical team in performing sentinel lymph node biopsy alone for cervical cancer?

  8. Are there any alternative methods for assessing lymph node involvement in cervical cancer, and why was sentinel lymph node biopsy chosen for my case?

  9. How will the sentinel lymph node biopsy be performed, and what can I expect during and after the procedure?

  10. Are there any specific lifestyle changes or precautions I should take before and after the sentinel lymph node biopsy?

Reference

Authors: Friedman EL, Guo XM, Furey KB, Lee AJ, Matsuzaki S, Kakuda M, Kobayashi M, Kodama M, Kanao H, Klar M, Roman LD, Wright JD, Matsuo K. Journal: Gynecol Oncol. 2025 May;196:182-191. doi: 10.1016/j.ygyno.2025.04.519. Epub 2025 Apr 19. PMID: 40253739