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. Conclusion 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. Data are available upon reasonable request.

中文翻译：

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宫颈癌前哨淋巴结清扫手术技术共识

目的 本研究旨在就宫颈癌前哨淋巴结（SLN）清扫手术技术达成共识。方法 通过电子邮件将包含 26 个问题的调查问卷发送给国际妇科肿瘤外科医生。使用两步改进的德尔菲法来建立共识。经过第一轮在线调查后，对问题进行了修改，并进行了第二轮和半结构化访谈。共识是使用 70% 的同意截止值来定义的。结果 38 名专家中有 25 名（65.8%）回答了第一轮和第二轮在线调查。第一轮有 13 个问题（50.0%）达成一致，最后一轮有 15 个问题（57.7%）达成一致≥70%。共识确定了 15 个推荐步骤、三个可选步骤和五个不推荐步骤。专家们商定了以下推荐程序：使用吲哚菁绿作为示踪剂；在 3 点和 9 点钟位置进行浅表（有或没有深层）注射；在未受累粘膜边缘注射，避开阴道穹窿；仅用镊子夹住子宫颈，部分子宫颈没有肿瘤；在简单子宫颈切除术/锥切术的情况下，使用微创方法进行前哨淋巴结活检； SLN 切除前识别输尿管、闭塞的脐动脉和髂外血管；从子宫动脉水平开始解剖并继续横向；并在进入对侧之前完成一侧半骨盆的解剖。还达成共识，建议不要在6点和12点注射，在肿瘤完全取代子宫颈的情况下直接注射到肿瘤内；防止在没有保护性操作的情况下通过端口移除节点；缺乏超分期方案；并反对在映射失败后重新注射时修改示踪剂浓度。结论 根据国际专家的共识，确定了宫颈癌前哨淋巴结切除的推荐、可选和不推荐步骤。这些代表了外科医生可以在临床试验中使用的手术指南以及在常规实践中用于质量保证的手术指南。数据可根据合理要求提供。