We thank Drs. Barranger and Darai for their letterconcerning our recent article in Cancer.1 However, we would like to clarify several points regarding their comments.

With regard to the false-negative rate, the value of this index is limited by the procedures used to identify metastasis in the lymph nodes. For example, in our study, the false-negative rate was 0% when using classic histologic techniques. However, with the use of serial sectioning and immunohistochemical techniques on all sentinel and nonsentinel lymph nodes, the false-negative rate in the same population was found to be 12.5% (3 of 24 patients).

In addition, Drs. Barranger and Darai recently published an article2 in which a procedure (serial sectioning and immunohistochemistry with an anticytokeratin antibody) similar to the one we used was performed. They found a false-negative rate of 0% in 18 cervical carcinoma patients in whom the sentinel lymph node was identified. However, their study has several limitations. First, the number of patients evaluated was only 18, whereas our study was based on 29 patients. Also, when closely examining their inclusion criteria, it appears that eight patients with advanced cervical tumors were included in the study by Drs. Barranger and Darai. These eight patients were treated first with chemoradiotherapy before undergoing the sentinel lymph node procedure. The value of the sentinel lymph node procedure after neoadjuvant treatment was not evaluated, and in our opinion these eight patients should not be included in a study evaluating the sentinel lymph node procedure. Lastly, the mean number of lymph nodes retrieved after a full systematic pelvic lymph node dissection was 10.5 per patient in their study, but it was nearly twice as high (19.4 per patient) in our study. We can assume that Drs. Barranger and Darai may have missed some lymph nodes that may have been involved by metastatic cells. Therefore, in our opinion, Drs. Barranger and Darai should not state that, in patients with cervical carcinoma, the sentinel lymph node procedure is reliable based on a study of only 10 patients. To define the value of the sentinel lymph node procedure precisely, a multicentric study with a minimum of 100 patients should be performed, in which the patients are evaluated with serial sectioning and immunohistochemistry of the sentinel and the nonsentinel lymph nodes. This type of study is currently underway in France involving not only our center but the team of Drs. Barranger and Darai as well. We hope that this study will define clearly the value of the sentinel lymph node procedure in patients with early cervical carcinoma.


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Patrice Mathevet M.D., Ph.D.*, * Department of Gynecology, Hospital Edouard Herriot, Lyon, France.