Annals of Surgical Oncology

, Volume 17, Issue 4, pp 1106–1110 | Cite as

Microscopic Evaluation of Lymph-Node-Bearing Tissue in Early-Stage Cervical Cancer: A Dual-Institution Review

  • Michael R. Milam
  • Lisa Abaid
  • Ricardo dos Reis
  • Michael Frumovitz
  • Paola A. Gehrig
  • Chad Livasy
  • Russell R. Broaddus
  • Pedro T. Ramirez
Gynecologic Oncology

Abstract

Objective

We compared two different methods of microscopic lymph node examination of cervical cancer radical hysterectomy specimens to ascertain which method translates into higher nodal counts and improved detection of nodal metastasis, at M. D. Anderson Cancer Center (MDACC) and the University of North Carolina (UNC).

Methods

We retrospectively reviewed the records of 155 patients with early-stage cervical cancer who underwent open radical hysterectomy and pelvic lymph node dissection from 2000 to 2006. At MDACC lymph nodes were grossly dissected from submitted adipose tissue surgical specimens and then microscopically examined. At UNC, grossly detected lymph nodes and the remaining adipose tissue were microscopically examined. Data regarding clinicopathologic features and lymph node dissection were available for all patients.

Results

No differences in stage, grade or histology were noted between the two centers. The median age and body mass index were both higher at MDACC (40 versus 36 years of age; 28 versus 26 mg/m2; P < 0.05) The median lymph node count was lower at MDACC (16 versus 23; P = 0.001). By multivariate analysis, UNC evaluation was associated with higher total lymph node count (P = 0.001). However, no significant difference was noted between institutions in proportion of patients with nodal metastases (MDACC 20.3%; UNC 13.5%; P = 0.47).

Conclusion

The UNC method of microscopically examining the entire adipose tissue sample may be associated with higher nodal count at open radical hysterectomy. Higher nodal count, however, may not translate into increased identification of nodal metastases.

References

  1. 1.
    Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58:71–96.CrossRefPubMedGoogle Scholar
  2. 2.
    Sedlis A, Bundy BN, Rotman MZ, Lentz SS, Muderspach LI, Zaino RJ. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A Gynecologic Oncology Group Study. Gynecol Oncol. 1999;73:177–83.CrossRefPubMedGoogle Scholar
  3. 3.
    Alvarez RD, Potter ME, Soong SJ, et al. Rationale for using pathologic tumor dimensions and nodal status to subclassify surgically treated stage IB cervical cancer patients. Gynecol Oncol. 1991;43:108–12.CrossRefPubMedGoogle Scholar
  4. 4.
    Buckley SL, Tritz DM, Van Le L, et al. Lymph node metastases and prognosis in patients with stage IA2 cervical cancer. Gynecol Oncol. 1996;63:4–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Marchiole P, Buenerd A, Benchaib M, Nezhat K, Dargent D, Mathevet P. Clinical significance of lympho vascular space involvement and lymph node micrometastases in early-stage cervical cancer: a retrospective case-control surgico-pathological study. Gynecol Oncol. 2005;97:727–32.CrossRefPubMedGoogle Scholar
  6. 6.
    Novakovic P, Mandic A, Vujkov T, et al. Radical hysterectomy for stage IB1 cervical carcinoma: lymph node metastasis as a prognostic factor. J Buon. 2002;7:247–50.PubMedGoogle Scholar
  7. 7.
    Chou HH, Chang TC, Yen TC, et al. Low value of [18F]-fluoro-2-deoxy-D-glucose positron emission tomography in primary staging of early-stage cervical cancer before radical hysterectomy. J Clin Oncol. 2006;24:123–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Rockall AG, Sohaib SA, Harisinghani MG, et al. Diagnostic performance of nanoparticle-enhanced magnetic resonance imaging in the diagnosis of lymph node metastases in patients with endometrial and cervical cancer. J Clin Oncol. 2005;23:2813–21.CrossRefPubMedGoogle Scholar
  9. 9.
    Milam MR, Frumovitz M, dos Reis R, Broaddus RR, Bassett RL Jr., Ramirez PT. Preoperative lymph-vascular space invasion is associated with nodal metastases in women with early-stage cervical cancer. Gynecol Oncol. 2007;106:12–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Wydra D, Sawicki S, Wojtylak S, Bandurski T, Emerich J. Sentinel node identification in cervical cancer patients undergoing transperitoneal radical hysterectomy: a study of 100 cases. Int J Gynecol Cancer. 2006;16:649–54.CrossRefPubMedGoogle Scholar
  11. 11.
    Di Stefano AB, Acquaviva G, Garozzo G, et al. Lymph node mapping and sentinel node detection in patients with cervical carcinoma: a 2-year experience. Gynecol Oncol. 2005;99:671–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Ferraris G, Lanza A, D’Addato F, et al. Techniques of pelvic and para-aortic lymphadenectomy in the surgical treatment of cervix carcinoma. Eur J Gynaecol Oncol. 1988;9:83–6.PubMedGoogle Scholar
  13. 13.
    Abu-Rustum NR, Gemignani ML, Moore K, et al. Total laparoscopic radical hysterectomy with pelvic lymphadenectomy using the argon-beam coagulator: pilot data and comparison to laparotomy. Gynecol Oncol. 2003;91:402–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Malur S, Possover M, Michels W, Schneider A. Laparoscopic-assisted vaginal versus abdominal surgery in patients with endometrial cancer—a prospective randomized trial. Gynecol Oncol. 2001;80:239–44.CrossRefPubMedGoogle Scholar
  15. 15.
    Boggess JF, Gehrig PA, Cantrell L, et al. A case-control study of robot-assisted type III radical hysterectomy with pelvic lymph node dissection compared with open radical hysterectomy. Am J Obstet Gynecol. 2008;199:357.e1–7.Google Scholar
  16. 16.
    Malur S, Possover M, Schneider A. Laparoscopically assisted radical vaginal versus radical abdominal hysterectomy type II in patients with cervical cancer. Surg Endosc. 2001;15:289–92.CrossRefPubMedGoogle Scholar
  17. 17.
    Frumovitz M, dos Reis R, Sun CC, et al. Comparison of total laparoscopic and abdominal radical hysterectomy for patients with early-stage cervical cancer. Obstet Gynecol. 2007;110:96–102.PubMedGoogle Scholar
  18. 18.
    Monk BJ, Cha DS, Walker JL, et al. Extent of disease as an indication for pelvic radiation following radical hysterectomy and bilateral pelvic lymph node dissection in the treatment of stage IB and IIA cervical carcinoma. Gynecol Oncol. 1994;54:4–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Roman LD, Felix JC, Muderspach LI, et al. Influence of quantity of lymph-vascular space invasion on the risk of nodal metastases in women with early-stage squamous cancer of the cervix. Gynecol Oncol. 1998;68:220–5.CrossRefPubMedGoogle Scholar
  20. 20.
    Delgado G, Bundy BN, Fowler WC Jr., et al. A prospective surgical pathological study of stage I squamous carcinoma of the cervix: a Gynecologic Oncology Group Study. Gynecol Oncol. 1989;35:314–20.CrossRefPubMedGoogle Scholar
  21. 21.
    Santoso JT, Azadi A, Wan J, Handorf C, Coleman RL, Tillmanns TD. Lymph node counts in uterine cancer: a randomized double blind trial. Gynecol Oncol. 2009;113:159–62.CrossRefPubMedGoogle Scholar
  22. 22.
    Brown HG, Luckasevic TM, Medich DS, Celebrezze JP, Jones SM. Efficacy of manual dissection of lymph nodes in colon cancer resections. Mod Pathol. 2004;17:402–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Hida J, Mori N, Kubo R, et al. Metastases from carcinoma of the colon and rectum detected in small lymph nodes by the clearing method. J Am Coll Surg. 1994;178:223–8.PubMedGoogle Scholar
  24. 24.
    Herrera L, Villarreal JR. Incidence of metastases from rectal adenocarcinoma in small lymph nodes detected by a clearing technique. Dis Colon Rectum. 1992;35:783–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Candela FC, Urmacher C, Brennan MF. Comparison of the conventional method of lymph node staging with a comprehensive fat-clearing method for gastric adenocarcinoma. Cancer. 1990;66:1828–32.CrossRefPubMedGoogle Scholar
  26. 26.
    Brooks SE, Chen TT, Ghosh A, Mullins CD, Gardner JF, Baquet CR. Cervical cancer outcomes analysis: impact of age, race, and comorbid illness on hospitalizations for invasive carcinoma of the cervix. Gynecol Oncol. 2000;79:107–15.CrossRefPubMedGoogle Scholar
  27. 27.
    Brun JL, Stoven-Camou D, Trouette R, Lopez M, Chene G, Hocke C. Survival and prognosis of women with invasive cervical cancer according to age. Gynecol Oncol. 2003;91:395–401.CrossRefPubMedGoogle Scholar
  28. 28.
    Frumovitz M, Sun CC, Jhingran A, et al. Radical hysterectomy in obese and morbidly obese women with cervical cancer. Obstet Gynecol. 2008;112:899–905.PubMedGoogle Scholar
  29. 29.
    Munstedt K, Wagner M, Kullmer U, Hackethal A, Franke FE. Influence of body mass index on prognosis in gynecological malignancies. Cancer Causes Control. 2008;19:909–16.PubMedGoogle Scholar
  30. 30.
    Chung HH, Kang SB, Cho JY, et al. Can preoperative MRI accurately evaluate nodal and parametrial invasion in early stage cervical cancer? Jpn J Clin Oncol. 2007;37:370–5.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • Michael R. Milam
    • 1
  • Lisa Abaid
    • 2
  • Ricardo dos Reis
    • 3
  • Michael Frumovitz
    • 4
  • Paola A. Gehrig
    • 2
  • Chad Livasy
    • 5
  • Russell R. Broaddus
    • 6
  • Pedro T. Ramirez
    • 4
  1. 1.Division of Gynecologic Oncology, Department of Obstetrics and GynecologyUniversity of Louisville Medical CenterLouisvilleUSA
  2. 2.Division of Gynecologic OncologyUniversity of North Carolina Medical Center at Chapel HillChapel HillUSA
  3. 3.Hospital de Clinicas de Porto Alegre, Gynecologic Oncology ServiceUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
  4. 4.Department of Gynecologic OncologyThe University of Texas M. D. Anderson Cancer CenterHoustonUSA
  5. 5.Division of Gynecologic PathologyUniversity of North Carolina Medical Center at Chapel HillChapel HillUSA
  6. 6.Department of PathologyThe University of Texas M. D. Anderson Cancer CenterHoustonUSA

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