Objectives To evaluate pre-operative radiology and histopathology findings in cervical cancer lymphadenopathy detection, allowing targeted FSE.
Methods A retrospective analysis was conducted of 203 early stage cervical cancer patients between 2010 and 2019 in a tertiary centre. All patients had histologically confirmed cervical cancer and underwent MRI prior to intraoperative FSE.
Results 19 patients were found to have lymph node metastases (LNM) (9.36%) at FSE. Patients were at increased risk of LNM by 6-fold with positive LVSI, 3-fold with MRI lymphadenopathy and 3.5-fold with MRI visible disease. The presence of lymphadenopathy on MRI and positive LVSI in combination increased the risk of LNM by 19-fold.
Conclusions We believe that intraoperative FSE has a role in the surgical management of early cervical cancer. However, we acknowledge that it is expensive and unpredictably time intensive, exposing patients to increased surgery duration and associated risk. We also recognise that it may not be feasible for all patients. By application of the preoperative risk stratification algorithm we demonstrate that FSE can be a useful tool to reduce surgical morbidity and avoid ineffective radical surgery or multimodal treatment in a cost effective manner in high-risk patients.
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