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Incidence of Lymph Node Metastases in Women With Low-Risk Early Cervical Cancer (<2 cm) Without Lymph-Vascular Invasion
  1. Lucas Minig, MD, PhD, MBA*,
  2. Anna Fagotti, MD,
  3. Giovanni Scambia, MD,
  4. Gloria Salvo, MD,
  5. María Guadalupe Patrono, MD§,
  6. Dimitrios Haidopoulos, MD,
  7. Ignacio Zapardiel, MD, PhD,
  8. Santiago Domingo, MD#,
  9. Maria Sotiropoulou, MD**,
  10. Gary Chisholm and
  11. Pedro T. Ramirez, MD
  1. * Gynecology Department, Instituto Valenciano de Oncología (IVO), Valencia, Spain;
  2. Department of Women's and Children's Health, Catholic University of the Sacred Heart, Rome, Italy;
  3. Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX;
  4. § Gynecology Department, Hospital Italiano de Buenos Aires, Argentina;
  5. Gynecologic Oncology Unit, Alexandra Hospital, Athens, Greece;
  6. Gynecologic Oncology Unit, La Paz University Hospital, IdiPAZ, Madrid; and
  7. # Gynecology Department, La Fe Hospital, Valencia, Spain; and
  8. ** Pathology Department, Alexandra University Hospital, Athens, Greece.
  1. Address correspondence and reprint requests to Lucas Minig, MD, PhD, MBA, Gynecology Department, Instituto Valenciano de Oncología (IVO), C/del Profesor Beltrán Baguena 8, 46009, Valencia, Spain. E-mail: miniglucas{at}


Objective To determine the incidence of lymph node metastasis in women with low-risk cervical cancer stage IA2 or IB1 (<2 cm) without lymph-vascular space invasion.

Methods A multicenter retrospective study was performed in patients who underwent radical or simple hysterectomy, conization, or trachelectomy plus pelvic lymphadenectomy for cervical cancer between January 2000 and June 2016.

Results A total of 271 patients were included in the study. Median age and body mass index were 46 years (range, 23–77 years) and 24 kg/m2 (range, 18–48 kg/m2), respectively. Twenty-two patients had stage IA2 (8.1%), and 249 (91.9%) had stage IB1. The median tumor size was 14 mm (range, 5–20 mm). Tumor grades were 1 (n = 63 [23.2%]), 2 (n = 120 [44.3%]), 3 (n = 63 [23.2%]), and unknown (25 [9.2%]). Median depth stromal invasion was 6 mm (range, 3–20 mm). Histologic subtypes included squamous (n = 171 [63.1%]), adenocarcinoma (n = 92 [33.9%]), and adenosquamous (n = 8 [3.0%]). Overall incidence of lymph node metastasis was 2.9% (n = 8). The incidence of lymph node involvement in G1, G2, and G3 was 0% (0/63), 5% (6/120), and 3.1% (2/63), respectively. No patient with stage IA2 (regardless of grade or histology) or G1 cervical cancer less than 2 cm (stage IB1) had lymph node metastasis.

Conclusions Patients with stage IA2 or IB1 (G1) with tumor size of less than 2 cm and no lymph-vascular space invasion may not need lymph node evaluation. On the other hand, 95% and 98% of patients with grade 2 or 3 tumors, respectively, could potentially undergo an unnecessary lymphadenectomy. Further studies with bigger sample size are required to confirm these results.

  • Cervical cancer
  • Early stage
  • Lymph node metastasis
  • Lymph-vascular space invasion

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  • The authors declare no conflicts of interest.