Separate lateral parametrial lymph node dissection improves detection rate of parametrial lymph node metastasis in early-stage cervical cancer: 10-year clinical evaluation in a single center in China

Objective: To investigate the clinical significance of separate lateral parametrial lymph node dissection(LPLND) in improving parametrial lymph node(PLN) and its metastasis detection rate during radical hysterectomy for early-stage cervical cancer.Methods: From July 2007 to August 2017, 2,695 patients with cervical cancer in stage IB1-IIA2 underwent radical hysterectomy were included. Of these patients, 368 underwent separate dissection of PLNs using the LPLND method, and 2,327 patients underwent conventional radical hysterectomy(CRH). We compared the surgical parameters, PLN detection rate and PLN metastasis rate between the two groups.Results: Compared with CRH group, the rate of laparoscopic surgery was higher(60.3% vs. 15.9%, P<0.001),and the blood transfusion rate was lower(19.0% vs. 29.0%, P<0.001) in the LPLND group. PLNs were detected in 356 cases(96.7%) in the LPLND group, and 270 cases(11.6%) in the CRH group(P<0.001), respectively. The number of PLNs detected in the LPLND group was higher than that in the CRH group(median 3 vs. 1, P<0.001).The PLN metastases were detected in 25 cases(6.8%) in the LPLND group, and 18 cases(0.8%) in the CRH group(P<0.001), respectively. In multivariable analysis, LPLND is an independent factor not only for PLN detection [odds ratio(OR)=228.999, 95% confidence interval(95% CI): 124.661-420.664;P<0.001], but also for PLN metastasis identification(OR=10.867, 95% CI: 5.381-21.946;P<0.001).Conclusions: LPLND is feasible and safe. The surgical method significantly improves the detection rate of PLN and avoids omission of PLN metastasis during radical hysterectomy for early-stage cervical cancer.

Can radical parametrectomy be omitted in occult cervical cancer after extrafascial hysterectomy?

Background: Occult invasive cervical cancer discovered after simple hysterectomy is not common, radical parame?trectomy(RP) is a preferred option for young women. However, the morbidity of RP was high. The aim of our study is to assess the incidence of parametrial involvement in patients who underwent radical parametrectomy for occult cervical cancer or radical hysterectomy for early?stage cervical cancer and to suggest an algorithm for the triage of patients with occult cervical cancer to avoid RP.Methods: A total of 13 patients with occult cervical cancer who had undergone RP with an upper vaginectomy and pelvic lymphadenectomy were included in this retrospective study. Data on the clinicopathologic characteristics of the cases were collected. The published literature was also reviewed, and low risk factors for parametrial involvement in early?stage cervical cancer were analyzed.Results: Of the 13 patients, 9 had a stage IB1 lesion, and 4 had a stage IA2 lesion. There were four patients with grade 1 disease, seven with grade 2 disease, and two with grade 3 disease. The median age of the entire patients was 41 years. The most common indication for extrafascial hysterectomy was cervical intraepithelial neoplasia 3. Three patients had visible lesions measuring 10–30 mm, in diameter and ten patients had cervical stromal invasions with depths ranging from 4 to 9 mm; only one patient had more than 50% stromal invasion, and four patients had lymph?vascular space invasion(LVSI). Perioperative complications included intraoperative bowel injury, blood transfusion, vesico?vaginal istula, and ileus(1 case for each). Postoperative pathologic examination results did not show residual disease or parametrial involvement. One patient with positive lymph nodes received concurrent radiation therapy. Only one patient experienced recurrence.Conclusions: Perioperative complications following RP were common, whereas the incidence of parametrial involve?ment was very low among selected early?stage cervical cancer patients. Based on these results, we thought that patients with very low?risk parametrial involvement(tumor size ≤2 cm, no LVSI, less than 50% stromal invasion, nega?tive lymph nodes) may beneit from omitting RP. Further prospective data are warranted.

Diagnostic Accuracy of MRI in Primary Cervical Cancer

Introduction: Magnetic resonance imaging (MRI) studies obtained during the initial staging of patients affected by uterine cervical cancer were compared to the final histological report after surgery. Methods: Data were retrieved from published papers. Results: MRI detection of lymph node metastases shows a sensitivity of 49.3% (1209 patients) and a specificity of 87.7% (1182 patients). Parametrial involvement detection has 66.2% sensitivity (1288 patients) and 83.6% specificity (1282 patients). MRI tumor size evaluation shows significant error. Even detection of over 1 cm diameter primary tumor can fail. MRI appears promising in the detection of myometrial and endometrial involvement. Conclusions: Primary uterine cervical cancer evaluation with routine MRI has a limited accuracy especially in the detection of lymph node involvement and parametrial invasion. It is not sensitive enough to replace histology of dissected nodes and parametria. Tumor size estimation is imprecise. Detection of myometrial and endometrial invasion using MRI might be possible. Awareness of MRI limitations is crucial in primary cervical cancer staging.

Clinical outcome following radical hysterectomy and pelvic lymphadenectomy for early-stage cervical cancer

Objective： To estimate the impact of parametrial infiltration and lymph node metastasis on clinical outcome in women with early-stage cervical cancer following radical hysterectomy and pelvic lymphadenectomy. Methods： Clinical records and pathologic slides of 532 patients with early-stage cervical cancer （330 Ib and 202 Ila） treated with radical hysterectomy and pelvic lymphadenectomy were reviewed. The study group comprised 520 patients with squamous call carcinoma and 12 patients with adenocarcinoma of the cervix. Median follow-up time was 67 months. The association among the various histopathologic predictors of outcome was determined with analysis. The influence of the predictors on outcome was examined with log rank survival methods and the Cox regression model. Results： FIGO stage, histologic type, tumor size, depth of invasion, parametdal infiltration, lymph node metastasis, and remote metastasis were identified as significantly biologically relevant and therefore were included as candidate predictors in multivariate analysis. In particular, parametrial infiltration and lymph node metastasis were found to be simultaneous predictors of death on multivariate analysis （P 〈 0.05）. After controlling for these two factors, the other variables considered were not statistically significant up to a two-way interaction. Conclusion： Presence of parametdal infiltration and/or lymph node metastasis in women with early-stage cervical cancer is an independent poor prognostic factor. In addition, the relatively poor survival of women with more than one lymph nodes identified with cancer cells.