In sentinel lymph node (SLN) mapping for early cervical cancer (Stage IA1 with LVSI to IB1), which tracer combination provides the highest detection rate and which injection site is standard?
- A Indocyanine green (ICG) ± technetium-99m injected at 3 and 9 o'clock positions of the cervix ✓
- B Isosulfan blue dye alone injected in the cervical stroma
- C Technetium-99m injected into the uterine fundus under ultrasound guidance
- D Methylene blue injected into the parametrium bilaterally
Explanation
Sentinel lymph node mapping in cervical cancer uses cervical injection (2 mL at 3 and 9 o'clock positions superficially and deeply at the ectocervix). The combination of ICG (detected by near-infrared imaging) plus technetium-99m provides the highest bilateral detection rates (>95%). ICG alone is now commonly used in minimally invasive surgery. The SLN algorithm (SENTICOL trials) requires bilateral pelvic SLN identification with ultrastaging for micrometastases. If SLN is not identified unilaterally, systematic ipsilateral lymphadenectomy is recommended. This approach avoids full lymphadenectomy and its complications in low-risk cases.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.