Detection of pelvic lymph node micrometastasis in stage IA2–IB2 cervical cancer by immunohistochemical analysis☆
Introduction
An estimated 12,200 women will be diagnosed with cervical cancer in 2003, and 4100 women will die of this disease [1]. Eighty percent of patients with invasive cervical carcinoma present with early stage disease (FIGO stage IA2–IB1); these patients are usually treated surgically with radical hysterectomy and pelvic lymphadenectomy and the overall survival rate is on the order of 80–90% [2]. Outcome is associated with a variety of prognostic factors, including size of the primary tumor, depth of stromal invasion, presence or absence of lymphatic space invasion, proximity to vaginal margins, and histological type.
The single most important prognostic factor for patients with low stage disease is the presence of lymph node metastases. For patients with stage IB disease, Delgado et al. [3] found a disease-free survival of 85.6% at 3 years for patients with negative pelvic lymph nodes versus 74.4% for patients with one or more positive lymph nodes. The incidence of pelvic lymph node metastases ranges from 8.5% to 21.4% for early stage disease (the incidence of paraaortic lymph node metastases ranges from 5% to 10% in stages IB and IIa disease), but the incidence and implications of lymph node micrometastasis are largely undetermined [2], [4].
Advances in the treatment of cervical cancer have focused on the incorporation of chemotherapy as a radiation sensitizer, and combination chemoradiation has been shown to improve survival and decrease the incidence of distant recurrence in patients with poor prognostic features [5], [6], [7]. Since patients with high-risk factors have been found to benefit from postoperative adjuvant treatment, the presence of pelvic lymph node micrometastases could theoretically play an important role in directing adjuvant therapy in patients with early stage disease in absence of other poor prognostic features [8].
Current methods of detecting lymph node metastasis in cervical cancer are limited to routine histopathological analysis. Although immunohistochemical analysis is currently used for the detection of breast cancer micrometastasis in sentinel lymph nodes and this procedure is being actively investigated in staging procedures for cervical cancer, the incidence and significance of micrometastases detected by immunohistochemical methods in cervical cancer are unknown. In order to address these issues, we examined the pelvic lymph nodes in lymphadenectomy specimens using immunohistological markers for cytokeratin and correlated these findings with other risk factors and outcome.
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Patients
Patients who underwent a radical hysterectomy and lymphadenectomy for stage IA2, IB1, and IB2 cervical cancer were identified by a retrospective computerized search of the pathology archived database at Stanford University from 1990 to 2000. Institutional review board approval was obtained for this study. All patients with FIGO stage IA2–IB2 were included (staging was based on International Federation of Gynecology and Obstetrics [FIGO] guidelines). Only patients whose preliminary biopsy or
Results
We retrospectively reviewed the medical records of 62 patients who underwent radical hysterectomy and lymphadenectomy for FIGO stage IA2–IB2 cervical cancer at Stanford University Hospital from 1990 to 2000 under an IRB approved protocol. A total of 49 patients with stage IA2–IB2 cervical cancer who underwent radical hysterectomy and lymphadenectomy with histologically negative lymph nodes were identified. Clinicopathologic characteristics of these patients are shown in Table 1. The mean age of
Discussion
In studies of other cancers, particularly breast cancer, routine histological examination has been found to underestimate the incidence of lymph node metastasis. Historically, it has been reported that serial sectioning of axillary lymph nodes reveals undetected metastases in 7–33% of breast cancer patients [10], [11], [12], [13]. Recently, attention has been turned to enhanced histopathological analysis using techniques such as reverse transcriptase PCR, flow cytometry, and immunohistochemical
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Value of routine cytokeratin immunohistochemistry in detecting low volume disease in cervical cancer
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2021, Journal of the Formosan Medical AssociationCitation Excerpt :The presence of nodal micrometastatic disease has been associated with adverse clinical outcomes in different solid malignancies, including gastric cancer,14–16 non-small cell lung cancer,17 and cervical cancer.18–22 Patients with micrometastases to pelvic lymph nodes from cervical malignancies may show evidence of lymphovascular invasion.18 However, other risk factors for recurrent cervical cancer (e.g., clinical stage, margin status, tumor histology, vascular invasion, preoperative radiation therapy, and tumor volume) did not seem to affect the occurrence of micrometastases.22
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2019, European Journal of Obstetrics and Gynecology and Reproductive BiologyThe Application of Sentinel Lymph Node Biopsy in Cervical Cancer
2018, Principles of Gynecologic Oncology Surgery
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Presented at the 31st Annual Meeting of the Western Association of Gynecologic Oncologists (WAGO), Newport Beach, CA, June 12–15, 2002.