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Accurate assessment of disease extent is required to select the best primary treatment for advanced epithelial ovarian cancer patients. Estimation of tumour burden is challenging and it is usually performed by means of a surgical procedure. Imaging techniques and tumour markers can help to estimate tumour burden non-invasively. 2-[18F]FDG PET/CT allows the evaluation of the whole-body disease. This study aimed to correlate HE4 and CA125 serum concentrations with tumour burden evaluated by volumetric 2-[18F]FDG PET/CT parameters in advanced high-grade epithelial ovarian cancer. We included 66 patients who underwent 2-[18F]FDG PET/CT and serum tumour markers determination before primary treatment. Volumes of interest were delimited in every pathological uptake. Whole-body metabolic tumour volume (wb_MTV) and total lesion glycolysis (wb_TLG) were calculated summing up every VOI’s MTV value. SUVmax thresholds were set at 40% (MTV40 and TLG40) and 50% (MTV50 and TLG50). In addition, four VOI subgroups were defined: peritoneal carcinomatosis, retroperitoneal nodes, supradiaphragmatic nodes, and distant metastases. MTV and TLG were calculated for each group by adding up the corresponding MTV values. TLG was calculated likewise. wb_MTV and wb_TLG were found to be significantly correlated with serum CA125 and HE4 concentrations. The strongest correlation was observed between HE4 and wb_MTV40 (r = 0.62, p

Introduction/Background* The aim of this study was to correlate the serum concentrations of tumor markers HE4 and CA125 with the tumor burden evaluated through the volumetric parameters of FDG-PET/CT FDG in patients with advanced epithelial ovarian cancer (EOC) before primary treatment. Methodology Sixty-six patients with advanced stage high grade serous ovarian carcinoma (HGSOC) or undifferentiated carcinoma (UOC) were included. Serum HE4, serum CA125 and FDG PET/CT were performed before primary treatment. Volumes of interest (VOIs) were delimited on every pathological uptake in PET images. Whole-body metabolic tumor volume (wbMTV) and total lesion glycolysis (wbTLG) were calculated as the sum of every single VOI value. SUVmax thresholds were set at 40% and 50%. Four VOIs subgroups were defined for analysis: carcinomatosis, retroperitoneal, supradiaphragmatic and metastases. MTV and TLG values were calculated for each of them. The associations between these parameters and serum tumor markers were assessed through Pearson and Spearman tests. Result(s)* When correlating wbMTV and wbTLG with both CA125 and HE4, significant associations were found. The strongest correlation was observed between HE4 and wbMTV40% (r=0.61, p Conclusion* Peritoneal tumor burden measured by FDG PET/CT volumetric parameters correlates better with HE4 than with CA125 in patients with advanced epithelial ovarian cancer. These results support the increasing utility of HE4 to improve the stratification of these patients in clinical practice

Introduction/Background* Systematic pelvic and paraortic lymphadenectomy is part of the initial epithelial ovarian cancer (EOC) staging surgery but this procedure is associated with potential severe morbidity. Moreover, there is no evidence suggesting a possible therapeutic value. The detection of the sentinel lymph node (SLN) in the early stage of EOC is in the experimental phase and there is little literature about it. This study evaluates the lymphatic mapping with radiotracer and indocyanine green (ICG)) and the detection of ovarian SLN. Methodology Prospective cohort study in ovarian masses suspected of malignancy or re-staging surgery after confirmed malignancy. Albumin [99mTc] Tc-nanocolloid was injected into the utero-ovarian and infundibulo-pelvic ligaments. After 15 minutes, intraoperative images were acquired with a portable gammacamera. Subsequently, the adnexectomy and intraoperative pathological analysis were performed. In the cases in which malignancy was confirmed, ICG was injected proximally to the sectioned area of the ligaments and the lymphatic chains were traced with the fluorescence camera prior to the pelvic and paraortic lymphadenectomy. Ultrastaging of the SLN was done. The follow-up for possible adverse events lasted 30 days after surgery. Result(s)* 20 patients were included between September-2020 and May-2021. Ovarian carcinoma was confirmed in 8 (40%) cases. In all cases gamma probe was used, in 60% the gamma camera and 40% the fluorescence camera. Some SLN was detected in 18/20 cases (90%) with exclusive paraortic drainage in 5/18 (28%), pelvic in 1/18 (6%) and in both territories in 12/18 (66%). Overall para-aortic drainage was observed in 17/18 (94%) patients (35% supramesenteric, 30% at the level of the inferior mesenteric artery, and 35% inframesenteric). 100% of aortic SLNs were detected with a gamma probe after being visualized with the gamma camera. In the 8 patients who underwent lymphadenectomy, 1 case had positive nodes diagnosed by ultrastaging and the rest of the lymph nodes were negative. No complications related to the technique were observed. Conclusion* The SLN technique is feasible and safe. The intraoperative gamma camera shows the lymphatic map and is especially useful in the paraortic region.

Introduction/Background* In patients with early-stage, grade 1-2, endometrioid endometrial cancer, preoperative assessment of myometrial invasion is essential to define the need of pelvic and paraaortic lymph node dissection. Our aim was to evaluate the role of three-dimensional transvaginal ultrasound (3D-TVUS) and diffusion-weighted magnetic resonance imaging (DW-RMI) for the assessment of myometrial infiltration in patients with well-differentiated (G1) or moderately differentiated (G2) endometrioid endometrial carcinoma (EC). Methodology We performed a retrospective observational study. Myometrial infiltration was assessed by 3D-TVUS and DW-MRI in 152 women with G1 or G2 endometroid EC who underwent surgical treatment in a tertiary referral center between 2012 and 2019. Sensitivity, specificity, predictive values and accuracy for the two techniques and for a combination of both were computed. Definitive histopathological data in the surgical specimen regarding myometrial infiltration was used as ‘Gold Standard’. Result(s)* One hundred and fifty-two patients were included, 120 (79%) patients presented myometrial infiltration 50%). 3D-TVUS and DW-MRI showed an agreement of 78.9% with a kappa index of 0.44 for the detection of deep myometrial infiltration. Sensitivity, specificity and accuracy of 3D-TVUS for the detection of deep myometrial infiltration were 71.0%, 80.5% and 78.5% respectively. Evaluation of myometrial infiltration with DW-MRI had a sensitivity, specificity and accuracy of 76.2%, 84.4% and 82.9% respectively. Association of both techniques increased sensitivity and specificity up to 84.6% and 93.2% and provided a low false negative rate (2.3%). Conclusion* The combination of 3D-TVUS and DW-RMI offers a high sensitivity and specificity to identify deep myometrial infiltration in patients with endometrioid G1 or G2 EC, thus these patients might benefit from performance of both techniques in preoperative evaluation.

Background Lower limb lymphoedema (LLL) is the most disabling adverse effect of surgical staging of pelvic lymph nodes. However, the lack of standardisation of volumetric LLL assessment hinders direct comparison between the studies and makes LLL reporting unreliable. The aim of our study is to report outcomes from a prospective trial that have implications for LLL assessment standardisation. Methods In the prospective international multicentre trial SENTIX, a group of 150 patients with stage IA1–IB2 cervical cancer treated by uterine surgery with bilateral sentinel lymph node biopsy was prospectively evaluated by objective LLL assessment, based on limb volume change (LVC) using circumferrential limb measurements and subjective patient-reported swelling. The assessments were conducted in six-month periods over 24 months post-surgery. Results Patient LVC substantially fluctuated in both positive and negative directions, which were comparable in frequency up to ±14% change. Thirty-eight patients experienced persistent LVC increase >10% classified as LLL, with nine months median time to onset. Some 34.2% of cases experienced onset later than one year after the surgery. Thirty-three patients (22%) experienced transient oedema characterised as LVC >10%, which resolved without intervention between two consequent follow-up visits. No significant correlation between LVC >10% and a patient-reported swelling was observed. Conclusions Given that we observed comparable fluctuations of the the lower-limb volumes after surgical treatment of cervical cancer in both positive and negative direction up to ±14%, the diagnostic threshold for LLL diagnosis based on LVC should be increased to >15% LVC. The distinction of transient oedema from persistent LLL requires repeated measurements. Also, as one-third of LLL cases are diagnosed >1-year post-surgery, a sufficient follow-up duration needs to be ensured. Patient-reported swelling correlated poorly with LVC and should only be used as an adjunct to objective LLL assessment. Trial registration: ClinicalTrials.gov : NCT02494063

Purpose: Indocyanine green (ICG) is frequently used for the detection of the sentinel lymph node (SLN) in gynecology, but it carries the loss of the presurgical SLN mapping provided by [99mTc]-based colloids. Hybrid tracers such as ICG-[99mTc] Tc-albumin nanocolloid combine the benefits of both components. The aim of this study was to evaluate the feasibility and applicability of this hybrid tracer injected by transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR) approach in the detection of SLNs in patients with intermediate- and high-risk EC. Methods: Fifty-two patients with intermediate- and high-risk EC underwent SLN biopsy after injection of a hybrid tracer using the TUMIR approach, followed by pelvic and paraaortic lymphadenectomy. SLNs were detected preoperatively by lymphoscintigraphic study and intraoperatively by gamma probe and near-infrared (NIR) optical laparoscopic camera. Results: Preoperative lymphatic drainage was obtained in 69% and intraoperative detection in 71.4% of patients. A total of 146 SLNs (4.17 SLNs/patient) were biopsied. Pelvic bilateral detection was observed in 57% of the women and paraaortic drainage in 34% of the patients. The radioactive component allowed the detection of SLN in 97.1% of the patients, while the fluorescent component detected 80%. In more than 17% of the patients with intraoperative detection, SLNs were detected only by the radioactive signal. Lymph node metastasis were identified in 14.3% of patients submitted to SLNB. The sensitivity and negative predictive value for metastatic involvement were 100%. Conclusion: TUMIR injection of a hybrid tracer in patients with intermediate- and high- risk EC combines the benefits of the radiotracer and the fluorescence methods with a single tracer. The method increases the paraaortic detection rate and allows a potential increase in SLN detection. Notwithstanding, based on our findings, the radioactive component of the hybrid tracer cannot be obviated.

Objective: To evaluate whether E7 mRNA can predict the risk of progression in women with HPV16 infection. Design: A prospective observational study. Setting: A tertiary university hospital. Population: A cohort of 139 women referred to colposcopy for an abnormal screening result fulfilling the following inclusion criteria: (1) a positive test result confirming HPV16 infection, (2) a biopsy sample with a histological diagnosis of an absence of lesion or low-grade SIL/CIN grade1 (LSIL/CIN1), (3) no previous HPV vaccination, (4) no pregnancy, and (5) no previous cervical treatments, and (6) no immunosuppression. Methods: At the first visit, all women underwent a cervical sample for liquid-based cytology, HPV testing and genotyping, and HPV16 E7 mRNA analysis and a colposcopy with at least one colposcopy-guided biopsy. Follow-up visits were scheduled every six months. In each control, a liquid-based Pap smear, HPV testing, as well as a colposcopy examination with biopsy if necessary were performed. Main outcome measures: Histological diagnosis of HSIL/CIN2+ at any time during follow-up. Results: E7 mRNA expression was positive in 55/127 (43.3%) women included in the study and seven (12.7%) progressed to HSIL/CIN2+. In contrast, only 1/72 (1.4%) women with no HPV16 E7 mRNA expression progressed (p = 0.027). HPV16 E7 mRNA expression was associated with a 10-fold increased risk of progression (HR 10.0, 95% CI 1.2–81.4). Conclusions: HPV16 E7 mRNA could be useful for risk stratification of women with HPV16 infection in whom a HSIL/CIN2+ has been ruled out. Funding: Instituto de Salud Carlos III (ICSIII)-Fondo de Investigación Sanitaria and ERDF ‘One Way to Europe’ (PI17/00772).

To assess oncologic outcomes in endometrial cancer patients with low-volume metastasis (LVM) in the sentinel lymph nodes (SLNs).Patients with endometrial cancer and SLN-LVM (≤2 mm) from December 3, 2009, to December 31, 2018, were retrospectively identified from 22 centers worldwide. Patients with International Federation of Gynecology and Obstetrics (FIGO) stage IV, adnexal involvement, or unknown adjuvant therapy (ATx) were excluded.Of 247 patients included, 132 had isolated tumor cell (ITC) and 115 had micrometastasis (MM). Overall 4-year recurrence-free survival (RFS) was 77.6% (95% CI, 70.2%-85.9%); median follow-up for patients without recurrence was 29.6 (interquartile range, 19.2-41.5) months. At multivariate analysis, Non-endometrioid (NE) (HR, 5.00; 95% CI, 2.50-9.99; P .001), lymphovascular space invasion (LVSI) (HR, 3.26; 95% CI, 1.45-7.31; P = .004), and uterine serosal invasion (USI) (HR, 3.70; 95% CI, 1.44-9.54; P = .007) were independent predictors of recurrence. Among 47 endometrioid ITC patients without ATx, 4-year RFS was 82.6% (95% CI, 70.1%-97.2). Considering 18 ITC patients with endometrioid grade 1 disease, without LVSI, USI, or ATx, only 1 had recurrence (median follow-up, 24.8 months).In patients with SLN-LVM, NE, LVSI, and USI were independent risk factors for recurrence. Patients with any risk factor had poor prognosis, even when receiving ATx. Patients with ITC and grade 1 endometrioid disease (no LVSI/USI) had favorable prognosis, even without ATx. Further analysis (with more patients and longer follow-up) is needed to assess whether ATx can be withheld in this low-risk subgroup.

Simple Summary Some recently published studies in early-stage cervical cancer patients have shown that minimally invasive surgery (MIS), including laparoscopic and robotic approaches, might offer lower survival rates than classic open surgery. We evaluated the oncological results of a series of patients treated by laparoscopically assisted radical vaginal hysterectomy (LARVH), an infrequently used MIS technique. We included 115 patients with early-stage cervical cancer (IA1 with lymphovascular invasion, IA2, IB1, and IIA < 2 cm; International Federation of Gynecology (FIGO), 2008). The 3- and 4.5-year disease-free survival rates were 96.7% and 93.5%, respectively, and the overall survival was 97.8% and 94.8%, respectively. These survival data are comparable with those reported with the open radical hysterectomy but presented the advantages of MIS. LARVH offers excellent disease control in women with early-stage cervical cancer and can be considered as an adequate MIS alternative to open radical hysterectomy. Abstract Background: Recent evidence indicates that some minimally invasive surgery approaches, such as laparoscopic and robotic-assisted radical hysterectomy, offer lower survival rates to patients with early-stage cervical cancer than open radical hysterectomy. We evaluated the oncological results of a different minimally invasive surgery approach, that of laparoscopically assisted radical vaginal hysterectomy (LARVH) in this setting. Methods: From January 2001 to December 2018, patients with early-stage cervical cancer were treated by LARVH. Colpotomy and initial closure of the vagina were performed following the Schauta operation, avoiding manipulation of the tumor. Laparoscopic sentinel lymph node (SLN) biopsy was performed in all cases. Women treated between 2001 and 2011 also underwent pelvic lymphadenectomy. Results: There were 115 patients included. Intraoperative complications occurred in nine patients (7.8%). After a median follow-up of 87.8 months (range 1–216), seven women (6%) presented recurrence. Four women died (mortality rate 3.4%). The 3- and 4.5-year disease-free survival rates were 96.7% and 93.5%, respectively, and the overall survival was 97.8% and 94.8%, respectively. Conclusion: LARVH offers excellent disease-free and overall survival in women with early-stage cervical cancer and can be considered as an adequate minimally invasive surgery alternative to open radical hysterectomy.

Introduction/Background Recent evidence indicates that some minimally invasive surgery (MIS) approaches, such as laparoscopic- and robotic-assisted radical hysterectomy, offer lower survival rates to patients with early-stage cervical cancer compared with open radical hysterectomy. We evaluated the oncological results of a different MIS approach, that of laparoscopically assisted radical vaginal hysterectomy (LARVH) in the treatment of patients with early-stage cervical cancer. Methodology From January 2001 to December 2018, patients with early-stage cervical cancer (IA1 with lymphovascular invasion, IA2, IB1, and IIA Results One hundred fifteen patients were included. Intraoperative complications occurred in nine patients (7.8%). Adjuvant radiotherapy or chemoradiotherapy was administered to 35 (30.4%) and three (2.6%) patients, respectively. After a median follow-up of 87.8 months (range 1–216), seven women (6%) presented recurrence (three pelvic and two paraaortic recurrences, and two had distant metastases). Four women died (mortality rate 3.4%). The three and 4.5-year disease-free survival rates were 96.7% and 93.5%, respectively, and the overall survival was 97.8% and 94.8%, respectively. Conclusion LARVH offers excellent disease-free and overall survival in women with early stage cervical cancer and can be considered as an adequate MIS alternative to open radical hysterectomy. Disclosures No disclosures to declare.

Introduction/Background Among patients with adnexal masses, preoperative identification of epithelial ovarian cancer (EOC) or metastatic cancer in the ovary (MCO) is essential for surgical planning. Our aim was to assess the performance of CA125, HE4, and the probability models, Risk of Ovarian Malignancy Algorithm (ROMA) and Copenhagen Index (CPH-I), to preoperatively identify EOC or MCO. Methodology We performed a single center retrospective study including women who underwent surgery for an ovarian tumor between January 2000 and December 2018. We defined two study groups: one group comprising women with benign pathology and borderline epithelial ovarian tumors and a second group comprising women with EOC or MCO. We computed sensitivity, specificity and predictive values of CA125, HE4, ROMA and CPH-I at different cutoff points. We performed receiver operative curve analysis for tumor markers, CPH-I and ROMA models. We performed subgroup analysis including only premenopausal, postmenopausal women, stage I EOC and women harboring ovarian tumors with inconclusive diagnosis of malignancy by ultrasound features. Results One thousand seventy-one patients were included, 852 (79.55%) presented benign or borderline epithelial tumors and 219 (20.45%) presented EOC or MCO. Area under the curve (AUC) for HE4 was significantly higher than AUC for CA125 (0.909 vs 0.873). No differences were seen between AUC of ROMA (0.939) and CPH-I (0.936), but they were both higher than HE4 AUC (figure 1). Subgroup analysis showed that in premenopausal women, HE4 performed better than CA125, and was equivalent to ROMA or CPH-I. Considering only ovarian tumors with inconclusive diagnosis by ultrasound, ROMA performed better than CPH-I. None of the tumor markers alone achieved a sensitivity of 90%, however HE4 was highly specific (93.5%). ROMA showed a sensitivity and specificity of 91.1% and 84.6% respectively, while CPH-I showed a sensitivity of 91.1% with 79.2% specificity (table 1). Conclusion Both ROMA and CPH-I were more favorable than tumor markers alone for differentiating patients harboring EOC or MCO. Probability models can be helpful in order to assess the risk of malignancy of ovarian tumors, especially when expert ultrasound examination is not available or when the diagnosis by ultrasound remains inconclusive. Disclosures The authors of this abstract have no disclosures.

Introduction/Background In patients with early-stage, grade 1–2, endometrioid endometrial cancer, preoperative assessment of myometrial invasion is essential to define the need of pelvic and paraaortic lymph node dissection. Our aim was to evaluate the role of three-dimensional transvaginal ultrasound (3D-TVUS) and diffusion-weighted magnetic resonance imaging (DW-RMI) for the assessment of myometrial invasion in patients with low-risk endometrial cancer. Methodology We performed a single center retrospective study, including patients who underwent surgery for grade 1–2 endometrioid endometrial cancer, FIGO stage I-II, in Hospital Clinic de Barcelona between 2010 and 2019. We computed sensitivity, specificity, and predictive values of 3D-TVUS and DW-RMI, as well as of intraoperative frozen section pathological study of surgical specimen, for diagnosis of deep myometrial invasion (≥50%). Definitive pathological analysis of surgical specimen was considered gold standard for diagnosis of deep myometrial invasion. Results One hundred and fifty-three patients were included, 120 (78.43%) patients presented myometrial invasion Conclusion The combination of 3D-TVUS and DW-RMI offers a better sensitivity, higher than intraoperative frozen section pathological study of the surgical specimen, for the diagnosis of deep myometrial invasion in patients with early-stage, grade 1–2, endometrioid endometrial cancer. Such information may be useful in selecting patients who require lymph node dissection. Disclosures The authors of this abstract have no disclosures.

Introduction/Background Sentinel lymph node (SLN) detection in patients with endometrial cancer (EC) is usually performed with a [99mTc] Tc-albumin nanocolloid radiotracer (RTs). The transvaginal ultrasound-guided myometrial injection of radiotracer, unlike cervical injection, is more representative of tumor’s drainage and obtains a higher percentage of SLN. Recently, the use of Indocyanine green (ICG) has gained relevance, although with this technique no pre-surgical lymphatic map is available. The hybrid tracer with RT-ICG could be an alternative to conserve the advantages of both components. The objective of this study is to see the performance of the detection of SLN with RT vs RT-CGI using the TUMIR technique in patients with EC at risk. Methodology It is a retrospective study which has included patients with stage I/II CE, high/intermediate risk. Detection of SLN has been performed using the TUMIR technique (figure 1) with RT (8 ml with 6 mCi of RT) between 2006 and 2017 or hybrid tracer RT-ICG (4 ml with 6 mCi of RT 0.05 ml of ICG (25 mg/ 5 ml)) between 2014 and 2019. A planar and tomographic lymphoscintigraphy (SPECT/CT) has been performed preoperatively (figure 2). After detection and excision of the SLN, a systematic pelvic and paraortic lymphadenectomy has been performed. The histological study of the SLN has been performed by H&E and IHC. Results A total of 155 patients have been included (102 with RT and 53 with ICG-RT). The intraoperative SLN detection in the RT group was 79.4% (92.6% of pelvic drainage, 45.7% of paraortic drainage and 7.4% exclusively paraortic). A bilateral drainage was found in 32% of the cases. A 19.6% of the patients had positive SLN (1.5% exclusively para-aortic). The percentage of false negative (FN) was 12.5%. The intraoperative SLN detection in the RT-ICG group was 68% (56% of pelvic drainage, 33% of paraortic drainage, without cases with exclusively paraortic drainage). A bilateral drainage was found in 56% of the cases. The 11.1% of the patients had a positive SLN without FN cases. Conclusion Detection of the SLN with RT is slightly higher than with hybrid tracer. The hybrid tracer obtains a higher percentage of SLN with bilateral pelvic drainage than RT and reduces the number of contralateral pelvic lymphadenectomies. The TUMIR technique allows detection of para-aortic SNs in more than 30% of patients, much higher than that obtained with other techniques. Disclosures No disclosures.

Objective The aim of this study was to evaluate the oncological outcomes of vaginal fertility-sparing surgery plus laparoscopic sentinel lymph node biopsy in patients with early cervical cancer over a 15-years period. Patients and methods From March 2005 to April 2018, 38 patients diagnosed with early stage cervical cancer underwent vaginal fertility-sparing surgery at the Hospital Clinic, Barcelona, Spain. Patients with FIGO stage IA1 with lymphovascular space invasion and stage IA2 underwent simple trachelectomy and patients with stage IB1 underwent radical vaginal trachelectomy. All cases underwent laparoscopic sentinel lymph node biopsy. In the first 19 cases, laparoscopic bilateral pelvic lymphadenectomy was completed immediately after sentinel lymph node biopsy. Clinical and oncological follow-up data were collected. Results The median age at diagnosis was 33.5 years (range 22–44). Simple trachelectomy was performed in seven cases (18.4%) and vaginal radical trachelectomy in 31 (81.6%). Nineteen patients were exclusively treated with laparoscopic sentinel lymph node biopsy and 19 with sentinel lymph node biopsy plus laparoscopic bilateral pelvic lymphadenectomy. There were no significant differences between the two lymph node assessment groups regarding histology and tumour size. The median follow-up was 73 months (range 1–160 months). There were 4 recurrences (3 patients with IB1 and 1 with IA2). Two occurred in the sentinel lymph node biopsy group and 2 in the sentinel lymph node biopsy plus laparoscopic bilateral pelvic lymphadenectomy group. All the recurrences were diagnosed in patients with adenocarcinoma and in 3 patients without lymphovascular space invasion. Conclusion Vaginal fertility-sparing surgery combined with laparoscopic sentinel lymph node biopsy seems to be a safe oncological procedure in selected patients with early stage cervical cancer. Further studies are needed to clarify the role of sentinel lymph node biopsy in fertility- sparing surgery in cervical cancer. Adenocarcinoma histology seems to be an important risk factor for recurrence.

Cervical cancer is the fourth most common cancer in women, and seventh overall. This disease represents a medical, economic and social burden. In early FIGO stage patients (IA, IB1 and IIA1), nodal involvement is the most important prognostic factor. Imaging evaluation of nodal metastasis is of limited value. In order to determine lymph node involvement, allow loco-regional control of the disease, define the need for adjuvant radiotherapy and improve survival, standard surgery for early disease is radical hysterectomy with systematic pelvic lymphadenectomy. However, this surgical treatment has risks and complications: longer operative time, larger blood loss, neurovascular or ureteral injury, lower-limb lymphedema, symptomatic lymphocysts, hydronephrosis. A method that allows to define the presence of regional metastasis with less morbidity and equal or greater precision is particularly relevant. The use of the sentinel lymph node biopsy is intended to reach that purpose. The present study reviews recent literature on the role of sentinel lymph node biopsy in cervical cancer, analyzing its indications and contraindications, injection and detection techniques, tracers used, surgical and pathological approaches and its applicability in up-to-date clinical practice.

Introduction/Background In early FIGO stage patients (IA, IB1 and IIA1) nodal involvement is one of the most important prognostic factors. Pelvic lymphadenectomy (LDN) is performed in order to assess lymph node involvement. Sentinel lymph node (SLN) biopsy has been increasingly used with limited evidence of oncological safety. Methodology Patients with FIGO stage IA1-IB1/IIA1 cervical carcinoma treated with radical surgery after lymph node assessment in Hospital Clinic (Barcelona, Spain) from 2001 to 2018 were included. Between 02/2001 and 05/2011 patients underwent SLN biopsy followed by complete pelvic LDN and patients from 06/2011 and 08/2018 underwent SLN dissection alone. Patients in whom SLN were detected unilaterally or not detected underwent a complete LDN of the failed mapped side. Radical surgery after intraoperative negative nodes were laparoscopic assisted vaginal radical hysterectomy or vaginal radical trachelectomy if fertility preservation desire. SLN were postoperative evaluated by pathologic ultrastaging. Intraoperative and postoperative as well as follow up data were prospectively recorded. STATA 15.1 was used for statistical analysis. Results In 162 patients lymph node assessment was performed, 87 (53.7%) underwent SLN biopsy followed by pelvic bilateral LDN and 75 (46.3%) SLNB only. No differences regarding age at diagnosis, size of the tumor (≤2 cm vs >2 cm), FIGO stage or histology type were seen between both groups. 151 patients had negative nodes. From these patients, 7 patients (9.1%) recurred in the LDN group and 3 patients (4.3%) in the SLN group. Cox hazard ratios were not statistically significant for lymph node assessment group. Conclusion Sentinel lymph node detection in patients with early cervical cancer does not entail an increased risk of recurrence with respect to the patients in whom a complete pelvic lymphadenectomy is performed. Disclosure The authors have no relationships/conditions/circumstances that present a potential conflict of interest.

Introduction/Background In early-stage cervical cancer, nodal involvement remains the most important prognostic factor. Imaging evaluation is not sensitive enough to replace histology. Achieving high detection rates is a prerequisite to introduce sentinel lymph node biopsy (SLNB). The aim of this study was to evaluate the evolution of SLNB detection techniques in women with early-stage cervical cancer treated in our institution. Methodology From 02/2001 until 01/2019, patients with FIGO 2009 stages IA1-IB1/IIA1 cervical carcinoma underwent SLNB. Those treated until 01/2010 endured SLNB followed by pelvic bilateral lymphadenectomy, thereafter only SLNB was performed. When SLNs were detected unilaterally or not detected, lymphadenectomy of the failed mapped side was performed. SLNB was achieved by laparoscopy after intracervical injection: first with blue dye (BD) plus radiocolloid (Tc) and, since 2014, with indocyanine green (ICG) also. SLN identification was performed with lymphoscintigraphy and SPECT/CT, facilitated by a laparoscopic gamma-probe and a fluorescence camera. Detection rate was calculated as the number of procedures in which at least one SLN was identified intraoperatively, divided by the total number of procedures undertaken. Results From 164 patients treated, 129 underwent SLNB with BD+Tc and 35 with BD+Tc+ICG. No differences regarding age at diagnosis, size of the tumor (≤2 cm vs >2 cm), FIGO stage, histologic subtype and surgical radicality were seen between both groups. In the first group, at least one SLN was identified in 123 cases, for an overall detection rate of 95.4%. The rate of bilateral detection was 61.2%. For the triple-technique group we detected SLNs in 35 cases, prompting a detection rate of 100%. SLNs were bilaterally detected in 34 patients (97.1%). Conclusion Both implemented techniques for SLNB in early-stage cervical cancer show a high detection rate. Nevertheless, triple technique with BD+Tc+ICG allows bilateral SLN detection in almost all patients. Disclosure Nothing to disclose.

Introduction/Background The aim was to evaluate the impact on survival depending on paraaortic (PA) nodes involvement and size of metastasis in locally advanced cervical cancer (LACC) after staging surgery and its safety before applying chemoradiotherapy treatment. Methodology We conducted a retrospective study in patients with LACC (FIGO stages from IB2 to IVA) from 2000 to 2016. All patients underwent MRI imaging and a laparoscopic staging PA lymphadenectomy (LSPAL). We performed an accurate ultrastaging of positive PA nodes and classified them in two groups (node metastasis >5 mm vs ≤5 mm) in order to compare the overall survival (OS). Radiation fields were extended to the PA area only in patients with PA nodes involvement. We evaluated the morbidity and mortality of the surgery. Results One hundred eighty three patients were diagnosed as a LACC. One hundred fifty patients had squamous carcinoma and thirty three patients adenocarcinoma. We observed 34 (18.5%) patients with PA nodal involvement (8 patients with PA metastasis measuring ≤5 mm and 20 measuring >5 mm). Six patients with lymph node metastasis did not have an ultrastaging study and were excluded from the analysis. Hazar Ratio for OS at 15 years were 2.51 (CI 0.90–6.98) for ≤5 mm metastasis (p 0.08) and 2.34 (CI 1.27–4.32) for >5 mm metastasis (p 0.007). Regarding surgical complications, 4 intraoperative events were reported (2,19%) although no perioperative mortality occurred. Thirteen (7.14%) early complications during the first month and 7(3.91%) late complications were reported with no mortality events. Conclusion The size of the paraaortic lymph node metastasis in patients with LACC has prognostic implications. Overall survival in patients with negative nodes or with metastasis ≤5 mm is similar. Paraaortic lymph node staging and extended-field radiotherapy represent a survival benefit in cases with positive nodes ≤5 mm. In LACC patients LSPAL seems a safe procedure. Disclosure Nothing to disclose.

Introduction/Background The aim of this study was to analyze the oncological outcomes and risk factors for recurrence of vaginal fertility-sparing surgery (FSS) and laparoscopic sentinel lymph node biopsy (SLNB) in patients with early cervical cancer (CC). Methodology From March 2005 to April 2018, 38 patients diagnosed with early stage CC underwent vaginal FFS at the Hospital Clinic, Barcelona, Spain. Patients with FIGO stage IA1 with lymphovascular space invasion (LVSI) and stage IA2 underwent simple trachelectomy and patients with stage IB1 underwent vaginal radical trachelectomy (VRT). All cases underwent laparoscopic SLNB. In the first cases, laparoscopic bilateral pelvic lymphadenectomy (LBPL) was completed immediately after SLNB. Clinical and oncological follow-up data were prospective collected. Results The median age at diagnosis was 33.5 years old (range 22–44). Simple trachelectomy was performed in seven cases (18.4%) and VRT in 31 (81.6%). Nineteen patients were treated with laparoscopic SLNB exclusively and 19 with SLNB plus LBPL. There were no significant differences between the two groups regarding histology and tumor size. The median follow-up was 73 months (range 1–160 months). There were 4 recurrences (3 patients with IB1 and one in IA2). Two occurred in the SLNB group and 2 in the SLNB plus LBPL group. All recurrences were diagnosed in patients with adenocarcinoma tumors and three without LVSI. Conclusion Vaginal FFS with laparoscopic SLNB seems to be a safe oncological procedure in early stage CC patients. Further studies are needed to clarify the role of adenocarcinoma histology as a prognostic factor of recurrence. Disclosure Nothing to disclose.