Can Conization Specimens Predict Sentinel Lymph Node Status in Early-Stage Cervical Cancer? A SENTICOL Group Study

Abstract

Background: The prognosis of patients with cervical cancer is significantly worsened in case of lymph node involvement. The goal of this study was to determine whether pathologic features in conization specimens can predict the sentinel lymph node (SLN) status in early-stage cervical cancer. Methods: An ancillary analysis of two prospective multicentric database on SLN biopsy for cervical cancer (SENTICOL I and II) was carried out. Patients with IA to IB2 2018 FIGO stage, who underwent preoperative conization before SLN biopsy were included. Results: Between January 2005 and July 2012, 161 patients from 25 French centers fulfilled the inclusion criteria. Macrometastases, micrometastases and Isolated tumor cells (ITCs) were found in 4 (2.5%), 6 (3.7%) and 5 (3.1%) patients respectively. Compared to negative SLN patients, patients with micrometastatic and macrometastatic SLN were more likely to have lymphovascular space invasion (LVSI) (60% vs. 29.5%, p = 0.04) and deep stromal invasion (DSI) ≥ 10 mm (50% vs. 17.8%, p = 0.04). Among the 93 patients with DSI < 10 mm and absence of LVSI on conization specimens, three patients (3.2%) had ITCs and only one (1.1%) had micrometastases. Conclusions: Patients with DSI < 10 mm and no LVSI in conization specimens had lower risk of micro- and macrometastatic SLN. In this subpopulation, full node dissection may be questionable in case of SLN unilateral detection.

A federated approach to identify women with early-stage cervical cancer at low risk of lymph node metastases

“…(2.8%) in a prospective study [20]. Likewise, in the prospective SENTICOL study, the authors found a low risk of metastases in tumours with < 10 mm depth of invasion and no LVSI (3% isolated tumour cells and 1% micrometastases) [21]. In contrast, we found a tumour size of ≤20 mm with LVSI and a depth of invasion > 10 mm to be related to a risk of 18.3%.…”

“…Preoperative estimation of the depth of invasion may be challenging if the tumour is only partially sampled-for example, after non-radical conization. However, Balaya et al [21] showed that final depth of invasion (≤10 mm or > 10 mm) is predicted correctly from conization specimens in 92% of the cases, irrespective of margin status. Moreover, interobserver agreement has been reported to be high (83%) in quantitative assessment [33].…”

“…Several studies have examined whether LVSI status after conization is predictive of the status after radical hysterectomy [21][22][23]. They found negative predictive values of 83-100%.…”

“…Recent prediction models have shown promising results (AUC 0.73-0.94 [27,28]), but they need to be tested for reproducibility and generalisability before implementation in daily practice. Final tumour size (≤20 mm or > 20 mm) can be predicted from conization specimens in 91-95% of the cases [21,23], even with positive margins [23]. Moreover, size can be determined more accurately if a conization precedes radical hysterectomy [29].…”

Special Issue: “Management of Early Stage Cervical Cancer”

“…Balaya and colleagues analyzed the risk factors that used to be associated with a higher incidence of positive lymph nodes in conization specimens: a depth stromal invasion <10 mm and no LVSI had a lower risk of micro- and macro-metastasis in SNL [ 5 ].…”