Risk of micrometastases in non-sentinel pelvic lymph nodes in cervical cancer

Cibula, David; Zikán, Michal; Sláma, Jiří; Fischerová, D.; Kocián, Roman; Germanová, Anna; Burgetová, Andrea; Dušek, Ladislav; Dundr, Pavel; Gregová, Mária; Němejcová, Kristýna

doi:10.1016/j.ygyno.2016.07.101

Cited by 41 publications

(42 citation statements)

References 16 publications

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“…Very few studies with small cohorts evaluated non-SLNs with an ultrastaging protocol, so the false-negative rate mostly compares the result of SLN ultrastaging with non-SLN standard assessment. 1,29,82,101 Finally, 27.4% (20 of 73 patients from 29 of 127 studies) of patients with false-negative results had SLNs located in the parametrial LN. This should not be considered as a false-negative result, since parametria are anatomically located between the cervix and regions of pelvic lymphadenectomy.…”

Section: Discussionmentioning

confidence: 97%

Pathologic Protocols for Sentinel Lymph Nodes Ultrastaging in Cervical Cancer

Dundr

Cibula

Němejcová

et al. 2019

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Ultrastaging of sentinel lymph nodes (SLNs) is a crucial aspect in the approach to SLN processing. No consensual protocol for pathologic ultrastaging has been approved by international societies to date. Objective.— To provide a review of the ultrastaging protocol and all its aspects related to the processing of SLNs in patients with cervical cancer. Data Sources.— In total, 127 publications reporting data from 9085 cases were identified in the literature. In 24% of studies, the information about SLN processing is entirely missing. No ultrastaging protocol was used in 7% of publications. When described, the differences in all aspects of SLN processing among the studies and institutions are substantial. This includes grossing of the SLN, which is not completely sliced and processed in almost 20% of studies. The reported protocols varied in all aspects of SLN processing, including the thickness of slices (range, 1–5 mm), the number of levels (range, 0–cut out until no tissue left), distance between the levels (range, 40–1000 μm), and number of sections per level (range, 1–5). Conclusions.— We found substantial differences in protocols used for SLN pathologic ultrastaging, which can impact sensitivity for detection of micrometastases and even small macrometastases. Since the involvement of pelvic lymph nodes is the most important negative prognostic factor, such profound discrepancies influence the referral of patients to adjuvant radiotherapy and could potentially cause treatment failure. It is urgent that international societies agree on a consensual protocol before SLN biopsy without pelvic lymphadenectomy is introduced into routine clinical practice.

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Section: Discussionmentioning

confidence: 97%

Pathologic Protocols for Sentinel Lymph Nodes Ultrastaging in Cervical Cancer

Dundr

Cibula

Němejcová

et al. 2019

Archives of Pathology &Amp; Laboratory Medicine

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“…Complete pelvic lymphadenectomy was not performed as at least one SLN was found per hemi-pelvises in these patients. In their study involving cervical cancer patients, Cibula et al [14] performed ultrastaging to both sentinel and non-sentinel lymph nodes and found that there is no risk of occult metastasis on non-SLNs when SLNs are negative. In the present study, ultrastaging of SLNs resulted negative in every patients and pathologic evaluation of non-SLNs showed no metastasis in the first 8 patients.…”

Section: Discussionmentioning

confidence: 99%

Simple vaginal trachelectomy for early stage cervical cancer: A tertiary cancer center experience

Demirkıran¹,

Kahramanoğlu²,

Beşe³

et al. 2018

Ginekol Pol

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Objectives: Less radical fertility sparing procedures have been introduced to reduce morbidity and adverse obstetric outcome in cervical cancer. Our objective was to describe oncological and obstetric outcomes of women with early-stage cervical cancer who underwent a simple vaginal trachelectomy (SVT). Material and methods: From 01/2013 to 05/2017, 14 women underwent SVT preceded by laparoscopic pelvic lymph node dissection. Results: Patients' median age was 32 years and all of them were nulliparous. Histology included squamous cell carcinoma and adenocarcinoma in 12 (85.7%) and 2 (14.3%) patients, respectively. Three patients had stage 1A1 with lymphovascular space invasion, 4 1A2 and 7 1B1. After obtaining final histopathology, one patient underwent radical hysterectomy due to positive surgical margin and excluded from analysis. None of the patients had lymph node metastasis. None of the 13 patients developed a recurrence within a median follow-up of 27 (6-56) months. Seven patients have conceived: 4 were term deliveries, 2 were late preterm deliveries and 1 was spontaneous abortion. Conclusions: SVT in well selected early-stage cervical cancer patients seems to be a safe treatment option with excellent oncologic outcome, preserving reproductive function. Literature data will need to be confirmed in large prospective series.

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“…17 Although prospective data are lacking, retrospective studies have suggested that micrometastasis is an independent poor prognostic factor for overall survival. [18][19][20][21] In our model, the presence of micrometastasis was treated as a high-risk criterion, and these patients were treated with adjuvant chemoradiation. There is little evidence about the prognostic significance and management of isolated tumor cells, and as such, these patients were managed as node-negative in our model.…”

Section: Decision Modelmentioning

confidence: 99%