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Assessment of pelvic lymph node micrometastatic disease in stages IB and IIA of carcinoma of the uterine cervix
  1. Jhtg Fregnani*,
  2. M. R.D.O Latorre,
  3. P. R. Novik,
  4. A. Lopes§ and
  5. F. A. Soares
  1. * Morphology Department, School of Medical Sciences of Santa Casa de São Paulo, São Paulo, Brazil
  2. Epidemiology Department, School of Public Health, University of São Paulo, São Paulo, Brazil
  3. Gynecology Department, “Hospital do Câncer A. C. Camargo” Treatment and Research Center, São Paulo, Brazil
  4. § Pelvic Surgery Department, “Hospital do Câncer A. C. Camargo” Treatment and Research Center, São Paulo, Brazil
  5. Pathology Department, “Hospital do Câncer A. C. Camargo” Treatment and Research Center, São Paulo, Brazil
  1. Address correspondence and reprint requests to: José Humberto Tavares Guerreiro Fregnani, PhD, Morphology Department, School of Medical Sciences of Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 61, CEP 01221-020 São Paulo, Brazil. Email: mdfregnani{at}terra.com.br

Abstract

The objective of this study was to assess the frequency of micrometastatic disease (MID) in pelvic lymph nodes (PLNs) in carcinoma of the uterine cervix (CUC) and to determine the risk of recurrence. The PLNs from 289 patients with CUC (IB and IIA) were studied. Each PLN was assessed via immunohistochemistry using a single histologic section (AE1/AE3). Metastatic deposits were measured and the disease status was classified into three groups: 1) absence of metastatic disease (MOD); 2) MID, one or more metastatic PLN with only isolated tumor cells and/or micrometastases (up to 2 mm); and 3) macrometastatic disease (MAD), presence of one or more metastatic PLN with macrometastases (more than 2 mm). Eleven patients (3.8%) were classified as having MID and 37 (12.8%) as having MAD. The 5-year disease-free survival (DFS) rates for MOD, MAD, and MID were 88.7%, 80.4%, and 50.0%, respectively (P < 0.001). The Cox proportional hazards model showed that MID was an independent variable for recurrence when adjusted for MAD, depth of tumor invasion, severity of inflammatory reaction, and use of adjuvant radiotherapy. We conclude that the frequency of MID in PLN was low. However, patients with MID presented a high risk of recurrence and reduced DFS.

  • carcinoma of the uterine cervix
  • lymph node
  • micrometastases
  • prognosis

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