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208 Risk factors for lymph node metastasis in women with cervical cancer who have small volume disease
  1. Hans HB Wenzel1,
  2. Tine H Schnack2,3,
  3. Maaike AVan Der Aa1,
  4. Pernille T Jensen4,5,6,
  5. Anna Norberg Hardie7,8,
  6. Henrik Falconer7,8 and
  7. Ruud LM Bekkers9,10
  1. 1Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
  2. 2University of Copenhagen, Copenhagen, Denmark
  3. 3Odense University Hospital, Odense, Denmark
  4. 4Aarhus University Hospital, Aarhus, Denmark
  5. 5Aarhus University, Aarhus, Denmark
  6. 6University of Southern Denmark, Odense, Denmark
  7. 7Karolinska University Hospital, Stockholm, Sweden
  8. 8Karolinska Institutet, Stockholm, Sweden
  9. 9Maastricht University Medical Centre+, Maastricht, The Netherlands
  10. 10Catharina Hospital, Eindhoven, The Netherlands


Introduction/Background In the FIGO 2018 classification, women with cervical cancer and a depth of invasion ≤5 mm and a horizontal spread of >7 mm, are now classified as stage IA instead of IB. This stage shift may reduce the likelihood of surgical pelvic lymph node evaluation, even in tumours with large horizontal width. It is therefore crucial to estimate the risk of lymph node metastasis (pN+) in this group and to identify risk factors for pN+.

Methodology Women diagnosed with cervical cancer between 2005 and 2022 were identified from three nationwide population-based registries: the Danish Gynaecological Cancer Database, the Swedish Quality Registry for Gynaecologic Cancer, and the Netherlands Cancer Registry. Inclusion criteria were squamous cell carcinoma or adenocarcinoma, FIGO 2009 stage IB1, a depth of invasion ≤5 mm and horizontal spread of >7 – ≤40 mm (independent of visibility), who underwent radical hysterectomy or radical trachelectomy and surgical pelvic lymph node evaluation. Logistic regression was used to identify risk factors of pN+.

Results A total of 993 women were included and 41 (4.1%) had pN+. Lymphovascular space invasion (LVSI) was the only significant risk factor of pN+ (odds ratio 4.28, 95% confidence interval [CI] 2.24–8.37). Accordingly, the risk of pN+ was 9.2% (95% CI 6.3–13.3%) in tumours with LVSI and 2.2% (95% CI 1.3–3.6%) in tumours without LVSI. The risk of pN+ was lowest in LVSI-negative tumours, with a size of ≤20 mm and a depth of invasion ≤3 mm (1.2%), while the risk was highest in LVSI-positive tumours with a size of 21–40 mm and a depth of invasion ≤3 mm (15.4%), as shown in figure 1.

Conclusion Lymph node staging should always be performed in the presence of LVSI. In the absence of LVSI, the risk of lymph node metastasis is generally low, but a more individualised approach may be warranted.

Disclosures No conflicts of interest to disclose.

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