Introduction The presence of lymph node metastasis in cervical cancer is considered to be an independent prognostic factor for risk of recurrence and survival. Cases with lymph node metastasis are classified as stage IIIC in FIGO 2018 classification. In this study, we investigated the consistency of preoperative imaging of lymph node enlargement with pathologic diagnosis, and its impact on prognosis in cervical cancer.

Methods We evaluated imaging and histological evaluation of pelvic lymph node, clinical stage, histological type, and oncologic outcome in 71 patients with cervical cancer who underwent radical hysterectomy in our hospital from 2014 to 2020.

Results Of the 14 patients with enlarged lymph nodes on imaging (r+), 11 had pathologic lymph node metastasis (group:r+p+) and 3 had no pathological metastasis (r+p-). In contrast, of the 57 patients without lymph node enlargement by imaging, 20 had pathologic lymph node metastasis (r-p+) and 37 did not (r-p-). In histologic types of r-p+ group were squamous cell carcinoma in 11 of 36 patients (30.6%) and adenocarcinoma in 9 of 35 patients (25.7%). Among adenocarcinoma, mucinous carcinoma of gastric type was the most common at 4 of 5(80.0%). The mean survival of r+p+, r-p+, and r+p- group was 65.9, 54.3, and 69.8 months, respectively, while 96.6 months for r-p- group.

Conclusion/Implications Patients with cervical cancer without lymph node enlargement on preoperative imaging but with pathologic lymph node metastasis had a similarly poor prognosis as those with enlarged lymph nodes on preoperative imaging.