Assessment of retroperitoneal lymph node status in locally advanced cervical cancer

Abstract

Background The assessment of retroperitoneal lymph node status in patients with locally advanced cervical cancer is still a problem. This study aimed to explore the choice of these assessment methods. Methods Laparoscopic retroperitoneal lymphadenectomy was performed in 96 patients with advanced cervical cancer. The positive rates of lymph node metastasis were analyzed. The values of computed tomography lymph node minimum axial diameter (MAD) and squamous cell carcinoma antigen (SCC-Ag), and their combination in predicting retroperitoneal lymph node metastasis were compared. High-risk factors for common iliac lymph node (CILN) and/or para-aortic lymph node (PALN) metastasis were analyzed. Results The lymph node metastasis rate was 62.50% and the CILN and/or PALN metastasis rate was 31.25%. Overall, 96 patients had 172 visible lymph nodes. The positive rate of lymph node metastasis was significantly higher in the MAD ≥1.0 cm group (83.33%) than in the 0.5 cm ≤ MAD < 1.0 cm group (26.82%). The critical values of MAD and SCC-Ag in determining lymph node metastasis were 1.0 cm and 5.2 ng/mL, respectively. The accuracy, specificity, and Youden index of MAD ≥1.0 cm combined with SCC-Ag ≥ 5.2 ng/mL for evaluating lymph node metastasis were 75.71%, 100%, and 0.59, respectively, and were significantly different from the values for the MAD ≥1.0 cm (72.09%, 80.56%, and 0.47, respectively) and SCC-Ag ≥ 5.2 ng/mL (71.43%, 68.97%, and 0.42, respectively) groups. Correlation analysis showed that non-squamous cell carcinoma, pelvic lymph node (PLN) MAD ≥1.0 cm plus number ≥ 2, and 1 PLN MAD ≥1.0 cm with CILN and/or PALN MAD 0.5–1.0 cm were risk factors for CILN and/or PALN metastasis. Conclusion Patients with MAD ≥1.0 cm and SCC-Ag ≥ 5.2 ng/mL, as well as high risk factors for CILN and/or PALN metastasis, should undergo resection of enlarged lymph nodes below the common iliac gland and lymphadenectomy of CILN/PALN to reduce tumor burden and to clarify lymph node metastasis status for accurate guidance in follow-up treatment. Patients with MAD < 1.0 cm and SCC-Ag < 5.2 ng/mL may be treated with chemoradiotherapy directly based on imaging, given the low lymph node metastasis rate.

Imaging evaluation of para-aortic lymph nodes in cervical cancer

“…For PALNs in cervical cancer, it was reported in the literature that the positive rate of lymph node metastasis in the group with minimum axial diameter ≥1.0 cm (83.33%) was significantly higher than that in the group with 0.5 cm ≤ MAD (minimum axial diameter) < 1.0 cm (26.82%). The cutoff value of the smallest axial diameter in determining lymph node metastasis is 1.0 cm (16). The study also yielded an area under the receiver operating characteristic (ROC) curve for the smallest axial diameter of lymph nodes on CT scan of 0.782 (95% confidence interval [CI] = 0.706–0.859).…”

Laparoscopic retroperitoneal para‐aortic lymph node biopsy in advanced cervical cancer with pelvic lymph node metastases: A single‐center prospective study

“…Another study showed that maximum axial diameter ≥10 mm on CT and SCC antigen level ≥5.2 ng/mL represent risk factors for lymph node metastases in cervical cancer. 16 The radiographic staging of PLN metastasis is difficult; however, since this area is within the scope of radiotherapy, its impact on prognosis is minimal. Since this study involved a small number of cases, the risks of false-negatives and false-positives were unknown.…”

“…In case 6, whose SCC antigen level was low (3.4 ng/mL) despite the large tumor size (60 mm), showed a smallest PLN metastasis size of 8 mm, and a SUVmax of 3.5. Another study showed that maximum axial diameter ≥10 mm on CT and SCC antigen level ≥5.2 ng/mL represent risk factors for lymph node metastases in cervical cancer 16 . The radiographic staging of PLN metastasis is difficult; however, since this area is within the scope of radiotherapy, its impact on prognosis is minimal.…”

Modern diagnostics and treatment of distant metastasis of cervical cancer

“…Первый выбор -хирургическая резекция. Парааортальная лимфодиссекция не только полезна для выявления потенциальных метастазов ЛУ у пациенток с раком шейки матки, но также обеспечивает терапевтический эффект [14]. Первоначально операция выполнялась путем лапаротомии, но от нее отказались из-за высокого уровня осложнений (от 10 до 16 %).…”