Lymphatic Spread of Cervical Cancer: An Anatomical and Pathological Study Based on 225 Radical Hysterectomies with Systematic Pelvic and Aortic Lymphadenectomy

Benedetti‐Panici, Pierluigi; Maneschi, Francesco; Scambia, Giovanni; Greggi, Stefano; Cutillo, Giuseppe; D'Andrea, Giorgia; Rabitti, Carla; Coronetta, Ferdinando; Capelli, Arnaldo; Mancuso, Salvatore

doi:10.1006/gyno.1996.0184

Cited by 258 publications

(136 citation statements)

References 8 publications

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“…Like other reports, our experience confirms the superiority of metabolic imaging to MRI for the detection of para-aortic, mediastinal and supra-clavicular lymph node metastases [18,19,20,31,32]. Unlike many series, however, our data highlight the technical limitations of 18 FDG PET for the evaluation of pelvic metastases, lymph node sites that most often harbour microscopic involvement and may even escape the intra-operative palpation [21,33,34]. Hence, 18 FDG PET appears to be the modality of choice for achieving an accurate N staging in patients with cervical cancers.…”

Section: N Stagingsupporting

confidence: 85%

Whole-body 18FDG PET plus pelvic MRI in the pre-treatment assessment of cervical cancers: an alternative to the FIGO clinical staging

Belhocine

2004

Gynecol Surg

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Growing evidence indicates that whole-body 18 F-fluorodeoxyglucose positron emission tomography (wb-18 FDG PET) plus pelvic magnetic resonance imaging (pMRI) may significantly improve the pre-treatment staging of primary cervical cancers. Such a combined protocol provides complementary insights into primary tumour delineation, loco-regional involvement and distant spread. As such, pMRI appears particularly reliable for the accurate measurement of tumour size, the detection of parametrial invasion and, even more so, for its exclusion. So far, wb-18 FDG PET yields unique information about extra-pelvic nodal and visceral tumour status. Of note, however, is the limitation of both imaging techniques for the detection of microscopic pelvic lymph node metastases, especially in early stage disease. Promising data also highlight the prognostic value of 18 FDG uptake as a marker of disease aggressiveness and of tumour resistance to treatment. The recent development of combined PET-CT scans as well as the validation of the sentinel node concept in gynaecological malignancies may grant new perspectives for optimal management of cervical cancers in the pre-treatment setting.

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Section: N Stagingsupporting

confidence: 85%

Whole-body 18FDG PET plus pelvic MRI in the pre-treatment assessment of cervical cancers: an alternative to the FIGO clinical staging

Belhocine

2004

Gynecol Surg

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“…In the past there was no evidence for sentinel node stations in cervical cancer. Benedetti-Panici et al examined lymphatic spread through paracervical tissue but found metastases in that area in only 29% (Benedetti-Panici et al, 1996). In cases of lymph node metastases the superficial obturator area was affected most commonly (86%).…”

Section: Discussionmentioning

confidence: 99%

Sentinel node procedure in Ib cervical cancer: a preliminary series

et al. 2001

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The aim of this study was to determine the diagnostic accuracy and feasibility of sentinel lymph node (SLN) detection using a gamma probe in patients with Figo IB cervical cancer. Between January 1999 and September 2000, 14 patients with cervical cancer, planned for radical hysterectomy were eligible for the study. The day before radical hysterectomy we injected technetium 99 m-labelled nanocolloid in each quadrant of the cervix. Dynamic and static images were recorded using a gamma camera. SLNs were identified intraoperatively using a handheld gamma-detection probe. After resection of SLNs a standard radical hysterectomy with pelvic lymph node dissection was performed. Patients and tumour characteristics were compared with sentinel node detection and with final histopathological and immunohistochemical results. Scintigraphy showed focal uptake in 13 of the 14 patients. Intraoperatively we detected 26 sentinel nodes by gamma probe. In 8 of 13 patients, one or more sentinel nodes were identified unilaterally, in 5 women bilaterally. Histologically positive SLNs were found in only 1 patient. We did not find any false-negative SLN in our series. In conclusion identification of sentinel nodes in cervical cancer is feasible with preoperatively administered technetium 99 m-labelled nanocolloid. A larger series will be required to establish sentinel node detection in cervical cancer for further therapy concepts and planning. © 2001 Cancer Research Campaign http://www.bjcancer.com

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“…Owing to the low rate of positive lymph node detected (ranging from 12 to 22%) 4 and the potential morbidity associated with a lymph node dissection, research has focused over recent years on the identification of primary tumor variables predictive of lymphatic spread. 5,6 In this context, lymphovascular space invasion has been described as an independent factor predicting tumor aggressiveness. 7 More recently, the lymphatic vessel density, which witnesses the level of lymphangiogenesis (formation of new lymphatic vessels), has been proposed as a new promising predictive variable of nodal extension.…”

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confidence: 99%

Improved computer-assisted analysis of the global lymphatic network in human cervical tissues

et al. 2014

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Lymphatic dissemination is a key event in cervical cancer progression and related tumor lymphatic markers are viewed as promising prognostic factor of nodal extension. However, validating such parameters requires an objective characterization of the lymphatic vasculature. Here, we performed a global analysis of the lymphatic network using a new computerized method applied on whole uterine cervical digital images. Sixty-eight cases of cervical neoplasia (12 CIN3, 10 FIGO stage 1A and 46 stage IB1) and 10 cases of normal cervical tissue were reacted with antibodies raised against D2-40, D2-40/p16 and D2-40/Ki67. Immunostained structures were automatically detected on whole slides. The lymphatic vessel density (D2-40), proliferating lymphatic vessel density (D2-40/ki67) and spatial lymphatic distribution in respect to the adjacent epithelium were assessed from normal cervix to early cervical cancer and correlated with lymphovascular space invasion and lymph node status. Prominent lymphatic vessel density and proliferating lymphatic vessel density are detected under the transformation zone of benign cervix and no further increase is noted during cancer progression. Notably, a shift of lymphatic vessel distribution toward the neoplastic edges is detected. In IB1 cervical cancer, although intra-and peritumoral lymphatic vessel density are neither correlated with lymphovascular space invasion nor with lymph node metastasis, a specific spatial distribution with more lymphatic vessels in the vicinity of tumor edges is predictive of lymphatic dissemination. Herein, we provide a new computerized method suitable for an innovative detailed analysis of the lymphatic network. We show that the transformation zone of the benign cervix acts as a baseline lymphangiogenic niche before the initiation of neoplastic process. During cancer progression, this specific microenvironment is maintained with lymphatic vessels even in closer vicinity to tumor cells.

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Lymphatic Spread of Cervical Cancer: An Anatomical and Pathological Study Based on 225 Radical Hysterectomies with Systematic Pelvic and Aortic Lymphadenectomy

Cited by 258 publications

References 8 publications

Whole-body 18FDG PET plus pelvic MRI in the pre-treatment assessment of cervical cancers: an alternative to the FIGO clinical staging

Whole-body 18FDG PET plus pelvic MRI in the pre-treatment assessment of cervical cancers: an alternative to the FIGO clinical staging

Sentinel node procedure in Ib cervical cancer: a preliminary series

Improved computer-assisted analysis of the global lymphatic network in human cervical tissues

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