open access

Vol 90, No 1 (2019)
Research paper
Published online: 2019-01-31
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The impact of low volume lymph node metastases and stage migration after pathologic ultrastaging of non-sentinel lymph nodes in early-stage cervical cancer: a study of 54 patients with 4.2 years of follow up

Marcin Sniadecki1, Dariusz Grzegorz Wydra1, Szymon Wojtylak2, Ewa Wycinka3, Marcin Liro1, Nikola Sniadecka4, Agnieszka Mrozinska5, Sambor Sawicki1
·
Pubmed: 30756367
·
Ginekol Pol 2019;90(1):20-30.
Affiliations
  1. Department of Gynecology, Gynecologic Oncology and Gynecologic Endocrinology, Medical University of Gdansk, Poland
  2. Department of Pathology, Medical University of Gdansk, Poland
  3. Department of Statistics, Faculty of Management, Gdansk University, Sopot, Poland
  4. Department of Chemical Technology, Faculty of Chemistry, Gdansk University of Technology, Gdansk, Poland
  5. Medical University of Gdansk, Poland

open access

Vol 90, No 1 (2019)
ORIGINAL PAPERS Gynecology
Published online: 2019-01-31

Abstract

Objectives: To assess the significance of pathologic ultrastaging (PU) of sentinel (SLN) and non-sentinel (nSLN) lymph nodes (LNs) and the influence on cancer staging in patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA2-IB1 cervical cancer.

Material and methods: A retrospective study was conducted with 54 patients divided into two equal-sized groups. In test group (n1), at least one SLN/patient was detected with blue dye. All excised LNs in this group were subjected to PU (4 μm slices/150 μm intervals) with hematoxylin-eosin staining and immunohistochemistry (AE1-AE3 antibodies). In none of the control group (n2) was PU performed, but in 2 patients SLN concept was performed. Patients in both groups underwent radical hysterectomy and lymphadenectomy. The effect of PU was expressed in puTNM and compared with both standard pTNM and FIGO systems. The influence of PU on patients’ disease-free survival (DFS) and overall survival (OS) was assessed using Kaplan-Meier curves.

Results: In total, 516 LNs were extracted (66 SLNs, 36% bilaterally). Micrometastases (MIC) or isolated tumor cells (ITC) were detected in 34 of the 482 LNs (7.1%), including 16 MICs and 9 ITC in non-SLNs. False negative rates were: 3.7%/side-specific, and 7.4%/both sides. The use of PU resulted in stage change in 2 cases (N and M status change), FIGO stage did not changed. No PU impact on DFS or OS was observed.

Conclusions: The risk of TNM stage migration in early cervical cancer is low, is more likely in inattentively evaluated patients, and has indeterminate prognostic and predictive value. Selection of cases with cT ≤ 2 cm and cN0 is sufficient to avoid the risk of improper staging.

Abstract

Objectives: To assess the significance of pathologic ultrastaging (PU) of sentinel (SLN) and non-sentinel (nSLN) lymph nodes (LNs) and the influence on cancer staging in patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA2-IB1 cervical cancer.

Material and methods: A retrospective study was conducted with 54 patients divided into two equal-sized groups. In test group (n1), at least one SLN/patient was detected with blue dye. All excised LNs in this group were subjected to PU (4 μm slices/150 μm intervals) with hematoxylin-eosin staining and immunohistochemistry (AE1-AE3 antibodies). In none of the control group (n2) was PU performed, but in 2 patients SLN concept was performed. Patients in both groups underwent radical hysterectomy and lymphadenectomy. The effect of PU was expressed in puTNM and compared with both standard pTNM and FIGO systems. The influence of PU on patients’ disease-free survival (DFS) and overall survival (OS) was assessed using Kaplan-Meier curves.

Results: In total, 516 LNs were extracted (66 SLNs, 36% bilaterally). Micrometastases (MIC) or isolated tumor cells (ITC) were detected in 34 of the 482 LNs (7.1%), including 16 MICs and 9 ITC in non-SLNs. False negative rates were: 3.7%/side-specific, and 7.4%/both sides. The use of PU resulted in stage change in 2 cases (N and M status change), FIGO stage did not changed. No PU impact on DFS or OS was observed.

Conclusions: The risk of TNM stage migration in early cervical cancer is low, is more likely in inattentively evaluated patients, and has indeterminate prognostic and predictive value. Selection of cases with cT ≤ 2 cm and cN0 is sufficient to avoid the risk of improper staging.

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Keywords

cervical cancer; ultrastaging; non-sentinel node; micrometastases

About this article
Title

The impact of low volume lymph node metastases and stage migration after pathologic ultrastaging of non-sentinel lymph nodes in early-stage cervical cancer: a study of 54 patients with 4.2 years of follow up

Journal

Ginekologia Polska

Issue

Vol 90, No 1 (2019)

Article type

Research paper

Pages

20-30

Published online

2019-01-31

Page views

1833

Article views/downloads

1326

DOI

10.5603/GP.2019.0004

Pubmed

30756367

Bibliographic record

Ginekol Pol 2019;90(1):20-30.

Keywords

cervical cancer
ultrastaging
non-sentinel node
micrometastases

Authors

Marcin Sniadecki
Dariusz Grzegorz Wydra
Szymon Wojtylak
Ewa Wycinka
Marcin Liro
Nikola Sniadecka
Agnieszka Mrozinska
Sambor Sawicki

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