%0 Journal Article
%T Consensus on surgical technique for sentinel lymph node dissection in cervical cancer.
%A Bizzarri N
%A Obermair A
%A Hsu HC
%A Chacon E
%A Collins A
%A Tsibulak I
%A Mutombo A
%A Abu-Rustum NR
%A Balaya V
%A Buda A
%A Cibula D
%A Covens A
%A Fanfani F
%A Ferron G
%A Frumovitz M
%A Guani B
%A Kocian R
%A Kohler C
%A Leblanc E
%A Lecuru F
%A Leitao MM
%A Mathevet P
%A Mueller MD
%A Papadia A
%A Pareja R
%A Plante M
%A Querleu D
%A Scambia G
%A Tanner E
%A Zapardiel I
%A Garcia JR
%A Ramirez PT
%J Int J Gynecol Cancer
%V 34
%N 4
%D 2024 Apr 1
%M 38378695
%F 4.661
%R 10.1136/ijgc-2023-005151
%X <B>OBJECTIVE: </B>The purpose of this study was to establish a consensus on the surgical technique for sentinel lymph node (SLN) dissection in cervical cancer.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.