Abstract：
OBJECTIVE: The purpose of this study was to establish a consensus on the surgical technique for sentinel lymph node (SLN) dissection in cervical cancer.
METHODS: A 26 question survey was emailed to international expert gynecological oncology surgeons. A two-step modified Delphi method was used to establish consensus. After a first round of online survey, the questions were amended and a second round, along with semistructured interviews was performed. Consensus was defined using a 70% cut-off for agreement.
RESULTS: Twenty-five of 38 (65.8%) experts responded to the first and second rounds of the online survey. Agreement ≥70% was reached for 13 (50.0%) questions in the first round and for 15 (57.7%) in the final round. Consensus agreement identified 15 recommended, three optional, and five not recommended steps. Experts agreed on the following recommended procedures: use of indocyanine green as a tracer; superficial (with or without deep) injection at 3 and 9 o\'clock; injection at the margins of uninvolved mucosa avoiding vaginal fornices; grasping the cervix with forceps only in part of the cervix is free of tumor; use of a minimally invasive approach for SLN biopsy in the case of simple trachelectomy/conization; identification of the ureter, obliterated umbilical artery, and external iliac vessels before SLN excision; commencing the dissection at the level of the uterine artery and continuing laterally; and completing dissection in one hemi-pelvis before proceeding to the contralateral side. Consensus was also reached in recommending against injection at 6 and 12 o\'clock, and injection directly into the tumor in cases of the tumor completely replacing the cervix; against removal of nodes through port without protective maneuvers; absence of an ultrastaging protocol; and against modifying tracer concentration at the time of re-injection after mapping failure.
CONCLUSIONS: Recommended, optional, and not recommended steps of SLN dissection in cervical cancer have been identified based on consensus among international experts. These represent a surgical guide that may be used by surgeons in clinical trials and for quality assurance in routine practice.
METHODS: A 26 question survey was emailed to international expert gynecological oncology surgeons. A two-step modified Delphi method was used to establish consensus. After a first round of online survey, the questions were amended and a second round, along with semistructured interviews was performed. Consensus was defined using a 70% cut-off for agreement.
RESULTS: Twenty-five of 38 (65.8%) experts responded to the first and second rounds of the online survey. Agreement ≥70% was reached for 13 (50.0%) questions in the first round and for 15 (57.7%) in the final round. Consensus agreement identified 15 recommended, three optional, and five not recommended steps. Experts agreed on the following recommended procedures: use of indocyanine green as a tracer; superficial (with or without deep) injection at 3 and 9 o\'clock; injection at the margins of uninvolved mucosa avoiding vaginal fornices; grasping the cervix with forceps only in part of the cervix is free of tumor; use of a minimally invasive approach for SLN biopsy in the case of simple trachelectomy/conization; identification of the ureter, obliterated umbilical artery, and external iliac vessels before SLN excision; commencing the dissection at the level of the uterine artery and continuing laterally; and completing dissection in one hemi-pelvis before proceeding to the contralateral side. Consensus was also reached in recommending against injection at 6 and 12 o\'clock, and injection directly into the tumor in cases of the tumor completely replacing the cervix; against removal of nodes through port without protective maneuvers; absence of an ultrastaging protocol; and against modifying tracer concentration at the time of re-injection after mapping failure.
CONCLUSIONS: Recommended, optional, and not recommended steps of SLN dissection in cervical cancer have been identified based on consensus among international experts. These represent a surgical guide that may be used by surgeons in clinical trials and for quality assurance in routine practice.
摘要：
目的：本研究的目的是就宫颈癌前哨淋巴结（SLN）清扫的手术技术达成共识。
方法：一项26个问题的调查通过电子邮件发送给国际妇科肿瘤外科专家。采用两步改进的德尔菲法建立共识。经过第一轮在线调查，问题被修改，第二轮，进行了半结构化访谈。共识是使用70%的协议截止来定义的。
结果：38位专家中有25位（65.8％）对第一轮和第二轮在线调查做出了回应。在第一轮中，有13个（50.0％）问题达成了≥70％的协议，在最后一轮中达成了15个（57.7％）的协议。共识协议确定了15个建议，三个可选，5个不推荐的步骤专家同意以下推荐的程序：使用吲哚菁绿作为示踪剂；在3点和9点进行表面（有或没有深度）注射；在未受累的粘膜边缘注射，避免阴道孔；用镊子抓住子宫颈，仅在子宫颈的一部分没有肿瘤；在简单的行囊/锥形切开术的情况下，使用微创方法进行SLN活检；识别输尿管切除术，脐动脉闭塞,SLN切除前和髂外血管；在子宫动脉水平开始解剖并横向继续；在进入对侧之前完成一个半骨盆的解剖。在建议6点和12点不注射方面也达成了共识，并在肿瘤完全替代子宫颈的情况下直接注射到肿瘤中;防止在没有保护性操作的情况下通过端口去除节点;没有超稳定方案;并防止在标测失败后重新注射时改变示踪剂浓度。
结论：推荐，可选,根据国际专家的共识，确定了不推荐的宫颈癌SLN解剖步骤。这些代表了外科指南，可供外科医生在临床试验中使用，并在常规实践中用于质量保证。
方法：一项26个问题的调查通过电子邮件发送给国际妇科肿瘤外科专家。采用两步改进的德尔菲法建立共识。经过第一轮在线调查，问题被修改，第二轮，进行了半结构化访谈。共识是使用70%的协议截止来定义的。
结果：38位专家中有25位（65.8％）对第一轮和第二轮在线调查做出了回应。在第一轮中，有13个（50.0％）问题达成了≥70％的协议，在最后一轮中达成了15个（57.7％）的协议。共识协议确定了15个建议，三个可选，5个不推荐的步骤专家同意以下推荐的程序：使用吲哚菁绿作为示踪剂；在3点和9点进行表面（有或没有深度）注射；在未受累的粘膜边缘注射，避免阴道孔；用镊子抓住子宫颈，仅在子宫颈的一部分没有肿瘤；在简单的行囊/锥形切开术的情况下，使用微创方法进行SLN活检；识别输尿管切除术，脐动脉闭塞,SLN切除前和髂外血管；在子宫动脉水平开始解剖并横向继续；在进入对侧之前完成一个半骨盆的解剖。在建议6点和12点不注射方面也达成了共识，并在肿瘤完全替代子宫颈的情况下直接注射到肿瘤中;防止在没有保护性操作的情况下通过端口去除节点;没有超稳定方案;并防止在标测失败后重新注射时改变示踪剂浓度。
结论：推荐，可选,根据国际专家的共识，确定了不推荐的宫颈癌SLN解剖步骤。这些代表了外科指南，可供外科医生在临床试验中使用，并在常规实践中用于质量保证。
