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

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.
Author Marcin Sniadecki
Marcin Sniadecki,,
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, Dariusz Grzegorz Wydra
Dariusz Grzegorz Wydra,,
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, Szymon Wojtylak
Szymon Wojtylak,,
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, Ewa Wycinka (FM / DS)
Ewa Wycinka,,
- Department of Statistics
, Marcin Liro
Marcin Liro,,
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, Nikola Sniadecka
Nikola Sniadecka,,
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, Agnieszka Mrozinska
Agnieszka Mrozinska,,
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, Sambor Sawicki
Sambor Sawicki,,
-
Journal seriesGinekologia Polska, ISSN 0017-0011, (A 15 pkt)
Issue year2019
Vol90
No1
Pages20-30
Publication size in sheets0.5
Keywords in Englishcervical cancer, ultrastaging, non-sentinel node, micrometastases
DOIDOI:10.5603/GP.2019.0004
URL https://journals.viamedica.pl/ginekologia_polska/article/download/GP.2019.0004/47471
Languageen angielski
Score (nominal)15
ScoreMinisterial score = 15.0, ArticleFromJournal
Ministerial score (2013-2016) = 15.0, ArticleFromJournal
Publication indicators WoS Impact Factor: 2017 = 0.621 (2) - 2017=0.553 (5)
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