Oscar Lührs1, Linnea Ekdahl2, Barbara Geppert2, Céline Lönnerfors2, Jan Persson3. 1. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology, Lund, Sweden; Department of Obstetrics and Gynecology, Ystad Lasarett, Ystad, Sweden. 2. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology, Lund, Sweden. 3. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology, Lund, Sweden. Electronic address: Jan.Persson@med.lu.se.
Abstract
OBJECTIVE: To investigate the prevalence of lymph nodes and lymph node metastases (LNMs) in the upper paracervical lymphovascular tissue (UPLT) in early stage cervical cancer. METHODS: In this prospective study consecutive women with stage IA1-IB1 cervical cancer underwent a pelvic lymphadenectomy including identification of sentinel nodes (SLNs) as part of a nodal staging procedure in conjunction with a robotic radical hysterectomy (RRH) or robotic radical trachelectomy (RRT). Indocyanine green (ICG) was used as tracer. The UPLT was separately removed and defined as "SLN-parametrium" and, as all SLN tissue, subjected to ultrastaging and immunohistochemistry. Primary endpoint was prevalence of lymph nodes and metastatic lymph nodes in the UPLT. Secondary endpoints were complications associated with removal of the UPLT. RESULTS: One hundred and forty-five women were analysed. Nineteen (13.1%) had pelvic LNMs, all identified by at least one metastatic SLN. In 76 women (52.4%) at least one UPLT lymph node was identified. Metastatic UPLT lymph nodes were identified in six women of which in three women (2.1% of all women and 15.8% of node positive women) without lateral pelvic LNMs. Thirteen women had lateral pelvic SLN LNMs with either no (n = 5) or benign (n = 8) UPLT lymph nodes. No intraoperative complications occurred due to the removal of the UPLT. CONCLUSION: Removal of the UPLT should be an integral part of the SLN concept in early stage cervical cancer.
OBJECTIVE: To investigate the prevalence of lymph nodes and lymph node metastases (LNMs) in the upper paracervical lymphovascular tissue (UPLT) in early stage cervical cancer. METHODS: In this prospective study consecutive women with stage IA1-IB1 cervical cancer underwent a pelvic lymphadenectomy including identification of sentinel nodes (SLNs) as part of a nodal staging procedure in conjunction with a robotic radical hysterectomy (RRH) or robotic radical trachelectomy (RRT). Indocyanine green (ICG) was used as tracer. The UPLT was separately removed and defined as "SLN-parametrium" and, as all SLN tissue, subjected to ultrastaging and immunohistochemistry. Primary endpoint was prevalence of lymph nodes and metastatic lymph nodes in the UPLT. Secondary endpoints were complications associated with removal of the UPLT. RESULTS: One hundred and forty-five women were analysed. Nineteen (13.1%) had pelvic LNMs, all identified by at least one metastatic SLN. In 76 women (52.4%) at least one UPLT lymph node was identified. Metastatic UPLT lymph nodes were identified in six women of which in three women (2.1% of all women and 15.8% of node positive women) without lateral pelvic LNMs. Thirteen women had lateral pelvic SLN LNMs with either no (n = 5) or benign (n = 8) UPLT lymph nodes. No intraoperative complications occurred due to the removal of the UPLT. CONCLUSION: Removal of the UPLT should be an integral part of the SLN concept in early stage cervical cancer.