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In a recent article, Marchiolè et al.,1 using serial sections and immunohistochemistry (IHC) staining to examine both sentinel lymph nodes (SLNs) and non-SLNs, attempted to determine whether the SLN is truly the lymph node most likely to harbor metastatic tumor and assessed the “true” histologic false-negative (FN) rate of SLNs in patients with cervical carcinoma. Using the colorimetric method alone, the authors found a high FN rate for SLN biopsy, thereby raising questions regarding the validity of this concept in patients with cervical carcinoma.

The FN rate is calculated as the number of procedures with a negative SLN (using hematoxylin and eosin [H&E] staining, multiple sectioning, and IHC analysis) and one or more positive non-SLNs (using “standard” histologic analysis) divided by the number of patients with any positive lymph node.2 To our knowledge, no consensus exists in cervical carcinoma with regard to an “acceptable” FN rate. Several parameters (including the method of detection, the injection site, the experience of the surgeon, and the use of systematic multiple sectioning and IHC analysis of the SLNs) can influence the FN rate. In the current study, using the colorimetric method alone, the “true” FN rate of the SLN mapping was not clearly reported. Using the “standard” method to evaluate the FN rate (i.e., multiple sectioning and IHC in the SLNs and conventional histologic analysis of non-SLNs [H & E]), we determined that the FN rate of the SLN procedure corresponded to 28.6% (2 of 7 patients), implying that this method of detection is not reliable in patients with cervical carcinoma. This high FN rate is not in keeping with the other studies in which a combined detection method was used. To our knowledge, SLN mapping has been reported in a total of 447 patients with cervical carcinoma in the literature to date. In these series, only 4 FN cases have been reported, for an overall rate of approximately 4%. In the study by Marchiolè et al.,1 the extended analysis of non-SLNs by serial sectioning and IHC allowed for the detection of only 1 micrometastasis in 1 non-SLN, increasing the FN rate to 12.5%. In contrast to Marchiolè et al.,1 we recently reported a study of 18 patients with cervical carcinoma who underwent a laparoscopic SLN procedure using a combined detection method.6 If the SLN was found to be free of metastasis by both H & E and IHC staining, all non-SLNs also were examined by the combined staining method. In 13 patients, no metastatic SLN involvement was detected by H & E and IHC staining. In these 13 patients, non-SLNs were examined using serial sectioning and IHC, and none was found to be metastatic. This confirms the finding that the SLN procedure appears to reliably predict the metastatic status of the regional lymphatic basin in patients with cervical carcinoma.

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Emmanuel Barranger M.D.*, Emile Darai M.D., Ph.D.*, * Departments of Gynecology and Obstetrics, Hôpital Tenon, Paris, France.