Pathological factors associated with non‐sentinel lymph node metastasis in early stage cervical cancer

Abstract

Objective To analyze the predictive factors for non‐sentinel lymph node (non‐SLN) metastasis in early‐stage cervical cancer. Methods We analyzed a series of 113 patients who underwent sentinel lymph node (SLN) mapping for cervical cancer. The SLNs were examined by immunohistochemistry (IHC) when the hematoxylin–eosin stain was negative. Results The overall bilateral detection rate was 81.5%, with a median of two SLNs resected. The study ultimately included 92 patients with SLNs that were mapped who had also undergone systematic pelvic lymph node dissection. Thirteen (14.1%) patients had positive SLNs, with a median of one positive SLN. Regarding the size of SLN metastasis, one (1.1%) had isolated tumor cells (ITC), seven (7.6%) had micrometastases, and five (5.4%) had macrometastases. Notably, 46.1% (6/13) had lymph node metastases detected only after IHC. Five (38.5%) cases had positive non‐SLNs, with a median count of one positive lymph node. Parametrial invasion was the only risk factor for positive non‐SLN (p = .045). Regarding the size of SLN metastasis, non‐SLN involvement was present in the only case with ITC (1/1), 42.9% (3/7) of cases with micrometastases, and in 20% (1/5) with macrometastases. Conclusions Our data suggest that parametrial invasion correlates with the risk of non‐SLN metastasis in cervical cancer.

Predictors of Non-Sentinel Lymph Node Metastasis in Patients with Positive Sentinel Lymph Node in Early-Stage Cervical Cancer: A SENTICOL GROUP Study

“…Of note, a recent retrospective study including 967 patients with FIGO T1a1L1-T2b cancers found out that the size itself of the metastasis did not impact disease-free survival (DFS) (but having a (+)SLN was of course negative on DFS) [46]. On this subject, our results are consistent with those of Diniz et al and the literature [47]. These results raised the question of the specificity of lymphatic spread in cervical cancer, and we support the idea that cervical cancer spreads differently from endometrial cancer in the lymphatic system.…”

“…This is most probably due to a lack of cases and, therefore, of power. Our univariate results are corroborated by Diniz's study [47]. They retained parametrial invasion as the only risk factor for positive non-SLN (p = 0.045).…”

Value of routine cytokeratin immunohistochemistry in detecting low volume disease in cervical cancer

“…Univariate analysis of risk factors for presence of low volume disease with immunohistochemistry in cervical cancer sentinel lymph nodes. of 13 patients (46%) with positive SLNs (including ITC) were detected only after IHC[12] In both studies it is not clear what type of metastasisi.e. clinically relevant or notwas additionally detected by IHC.…”

“…Current guidelines advise routine use of immunohistochemistry (IHC) when ultrastaging SLNs from cervical cancer patients [11]. Immunohistochemistry facilitates detection of micrometastasis and ITC by demonstrating tumor specific proteins, even when these tumor cells are not seen on examination of multiple step sections [3,5,12]. However, the added clinical value of IHCin terms of finding low volume disease that adjusts therapeutic strategyremains uncertain, while its routine use is time-consuming and costly.…”

Prognostic Significance of the Criteria for Metastatic Involvement of Regional Lymph Nodes in Cervical Cancer According to Magnetic Resonance Imaging Findings

“…Состояние лимфатических узлов (ЛУ) является важнейшим прогностическим фактором при ранней стадии рака шейки матки (РШМ) и основным критерием для назначения адъювантной терапии [3]. В пересмотренной классификации Международной федерации…”