Can We Define the Risk of Lymph Node Metastasis in Early-Stage Cervical Cancer Patients? A Large-Scale, Retrospective Study

Ferrandina, Gabriella; Gallotta, Valerio; Fagotti, Anna; Vizza, Enrico; Chiàntera, Vito; Iaco, Pierandrea De; Ercoli, Alfredo; Corrado, Giacomo; Bottoni, Carolina; Fanfani, Francesco

doi:10.1245/s10434-017-5917-0

Cited by 37 publications

(33 citation statements)

References 29 publications

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“…We highlighted that tumor size larger than 20 mm was an independent risk-factor of false negativity of SLN and this finding was consistent with Slama et al who reported that the false-negative rate of frozen section was higher in bigger tumors (N20 cm 3 ) [10]. The larger the tumor is the higher the probability of nodal metastasis is [28,29]. By contrast, the risk of nodal metastasis, including ITCs and micrometastases, is lower in the subset of patients with smaller tumor size [28,30].…”

Section: Discussionsupporting

confidence: 90%

Diagnostic value of frozen section examination of sentinel lymph nodes in early-stage cervical cancer at the time of ultrastaging

Balaya

Guani

Benoit³

et al. 2020

Gynecologic Oncology

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Objectives. We aimed to assess the diagnostic value of frozen-section pathologic examination (FSE) of sentinel lymph nodes (SLN) in patients with early-stage cervical cancer. Methods. Two French prospective multicentric database on SLN biopsy for cervical cancer (SENTICOL I and II) were analysed. Patients with IA to IIA1 2018 FIGO stage, who underwent SLN biopsy with both FSE and ultrastaging examination were included. Results and discussion. Between 2005 and 2012, 313 patients from 25 centers fulfilled the inclusion criteria. Metastatic involvement of SLN was diagnosed in 52 patients (16.6%). Macrometastases, micrometastases and isolated tumor cells (ITCs) were found in 27, 12 and 13 patients respectively. Among the 928 SLNs analysed, FSE identified 23 SLNs with macrometastases in 20 patients and 5 SLNs with micrometastases in 2 patients whereas no ITCs were identified. Ultrastaging of negative SLNs by FSE found macrometastases, micrometastases and ITCs in additional 7, 11 and 17 SLNs. Ultrastaging increased significantly the rate of patients with positive SLN from 7% to 16.6% (p b 0.0001). The sensitivity and the negative predictive value of FSE were 42.3% and 89.7% respectively or 56.4% and 94.1% if ITCs were excluded. False-negative cases were more frequent with tumor size ≥ 20 mm (OR = 4.46, 95%IC = [1.45-13.66], p = 0.01) and preoperative brachytherapy (OR = 4.47, 95%IC = [1.37-14.63], p = 0.01) and less frequent with patients included in higher volume center (N5 patients/year) (OR = 0.09, 95%IC = [0.02-0.51], p = 0.01).

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Section: Discussionsupporting

confidence: 90%

Diagnostic value of frozen section examination of sentinel lymph nodes in early-stage cervical cancer at the time of ultrastaging

Balaya

Guani

Benoit³

et al. 2020

Gynecologic Oncology

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“…Radical hysterectomy and pelvic lymph node dissection (PLND) are the conventional curative treatment options for stage IB-IIA cervical cancers, recommended by the International Federation of Gynecology and Obstetrics (FIGO) guidelines. However, approximately 10%−30% of patients with early-stage cervical cancer harbor LNM (6,7). Adjuvant chemoradiotherapy is recommended for these patients with LNM diagnosed pathologically after surgery.…”

Section: Introductionmentioning

confidence: 99%

Radiomics Analysis of Multiparametric MRI for the Preoperative Prediction of Lymph Node Metastasis in Cervical Cancer

Hou

Zhou

Ren³

et al. 2020

Front. Oncol.

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Objective: To develop and validate a radiomics predictive model based on multiparameter MR imaging features and clinical features to predict lymph node metastasis (LNM) in patients with cervical cancer. Material and Methods: A total of 168 consecutive patients with cervical cancer from two centers were enrolled in our retrospective study. A total of 3,930 imaging features were extracted from T2-weighted (T2W), ADC, and contrast-enhanced T1-weighted (cT1W) images for each patient. Four-step procedures, mainly minimum redundancy maximum relevance (MRMR) and least absolute shrinkage and selection operator (LASSO) regression, were applied for feature selection and radiomics signature building in the training set from center I (n = 115). Combining clinical risk factors, a radiomics nomogram was then constructed. The models were then validated in the external validation set comprising 53 patients from center II. The predictive performance was determined by its calibration, discrimination, and clinical usefulness. Results: The radiomics signature derived from the combination of T2W, ADC, and cT1W images, composed of six LN-status-related features, was significantly associated with LNM and showed better predictive performance than signatures derived from either of them alone in both sets. Encouragingly, the radiomics signature also showed good discrimination in the MRI-reported LN-negative subgroup, with AUC of 0.825 (95% CI: 0.732-0.919). The radiomics nomogram that incorporated radiomics signature and MRI-reported LN status also showed good calibration and discrimination in both sets, with AUCs of 0.865 (95% CI: 0.794-0.936) and 0.861 (95% CI: 0.733-0.990), respectively. Decision curve analysis confirmed its clinical usefulness. Conclusion: The proposed MRI-based radiomics nomogram has good performance for predicting LN metastasis in cervical cancer and may be useful for improving clinical decision making.

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“…However, there are still some unsolved issues, including SLN detection rate, which may be influenced by methodology (number and type of tracers) and type of surgical approach, diagnostic accuracy, and sensitivity and specificity of the procedure. 11 All these factors influence the routine use of SLN biopsy in practice. Sensitivity and specificity of the procedure are closely related to optimal bilateral detection of SLNs and also to the pathologic examination of the SLN, although the pathology protocol for SLN examination has not yet been standardized.…”

mentioning

confidence: 99%

Pathologic Protocols for Sentinel Lymph Nodes Ultrastaging in Cervical Cancer

Dundr

Cibula

Němejcová

et al. 2019

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Ultrastaging of sentinel lymph nodes (SLNs) is a crucial aspect in the approach to SLN processing. No consensual protocol for pathologic ultrastaging has been approved by international societies to date. Objective.— To provide a review of the ultrastaging protocol and all its aspects related to the processing of SLNs in patients with cervical cancer. Data Sources.— In total, 127 publications reporting data from 9085 cases were identified in the literature. In 24% of studies, the information about SLN processing is entirely missing. No ultrastaging protocol was used in 7% of publications. When described, the differences in all aspects of SLN processing among the studies and institutions are substantial. This includes grossing of the SLN, which is not completely sliced and processed in almost 20% of studies. The reported protocols varied in all aspects of SLN processing, including the thickness of slices (range, 1–5 mm), the number of levels (range, 0–cut out until no tissue left), distance between the levels (range, 40–1000 μm), and number of sections per level (range, 1–5). Conclusions.— We found substantial differences in protocols used for SLN pathologic ultrastaging, which can impact sensitivity for detection of micrometastases and even small macrometastases. Since the involvement of pelvic lymph nodes is the most important negative prognostic factor, such profound discrepancies influence the referral of patients to adjuvant radiotherapy and could potentially cause treatment failure. It is urgent that international societies agree on a consensual protocol before SLN biopsy without pelvic lymphadenectomy is introduced into routine clinical practice.

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Can We Define the Risk of Lymph Node Metastasis in Early-Stage Cervical Cancer Patients? A Large-Scale, Retrospective Study

Abstract: Defining the precise risk of LNM could lead to proper selection of patients in whom any lymph nodal procedure, including SLN, could be avoided.

Cited by 37 publications

References 29 publications

Diagnostic value of frozen section examination of sentinel lymph nodes in early-stage cervical cancer at the time of ultrastaging

Diagnostic value of frozen section examination of sentinel lymph nodes in early-stage cervical cancer at the time of ultrastaging

Radiomics Analysis of Multiparametric MRI for the Preoperative Prediction of Lymph Node Metastasis in Cervical Cancer

Pathologic Protocols for Sentinel Lymph Nodes Ultrastaging in Cervical Cancer

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