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Distribution Pattern of Circumflex Iliac Node Distal to the External Iliac Node Metastasis in Stage IA to IIA Cervical Carcinoma
  1. Yue-ju Yin, MD*,,
  2. Hui-qin Li, MD,,
  3. Xiu-gui Sheng, PhD*,,
  4. Xing-lan Li, MD*, and
  5. Xiang Wang, MD*,
  1. *Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute;
  2. School of Medicine and Life Sciences, University of Jinan - Shandong Academy of Medical Sciences; and
  3. Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, People’s Republic of China.
  1. Address correspondence and reprint requests to Xiu-gui Sheng, PhD, Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, 440 Jiyan Rd, Huaiyin District, Jinan 250117, Shandong Province, People’s Republic of China. E-mail: jnsxg{at}


Objectives This study aimed to investigate the metastatic rate of circumflex iliac node distal to the external iliac node (CINDEIN) and its associations with clinicopathological factors in patients with stage IA to IIA cervical cancer to determine whether dissection of CINDEIN had a role in surgery of these patients.

Methods Six hundred thirty-three patients with the International Federation of Gynecology and Obstetrics stage IA to IIA cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy were retrospectively reviewed. The metastatic rate and distribution of the pelvic lymph nodes (PLNs) and CINDEINs were analyzed.

Results The PLN metastatic rate was 25.6% (162 of 633 patients). Sixteen of 162 node-positive patients had CINDEIN metastases. Only 1 patient without PLN metastases had positive CINDEIN nodes. Univariate analysis revealed that other PLNs (including lymph nodes collected from obturator, external iliac, and internal iliac regions) and lymph vascular space involvement were the risk factors of CINDEIN metastases (P < 0.05). Other PLN metastasis (odds ratio, 50.6; 95% confidence interval, 6.6–386.7) was an independent risk factor for metastasis to CINDEIN by binary logistic regression analysis.

Conclusions Circumflex iliac node distal to the external iliac node metastases seemed to occur secondarily to widespread PLN metastases. In early stage cervical cancer, removal of the CINDEIN as a routine surgical procedure might be omitted to reduce operation time and minimize surgical morbidity.

  • Cervical carcinoma
  • Pelvic lymph node
  • Circumflex iliac node
  • Metastasis

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  • The authors declare no conflicts of interest.

  • Yue-ju Yin and Hui-qin Li equally contributed to this work.