Lymph nodes metastasis in cervical cancer: Incidences, risk factors, consequences and imaging evaluations

Du, Rongxu; Li, Lei; Ma, Shuiqing; Tan, Xiaojie; Zhong, Sen; Wu, Ming

doi:10.1111/ajco.12997

Cited by 35 publications

(24 citation statements)

References 33 publications

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“…For patients with early-stage cervical cancer, LN metastasis has been proven to be a critical risk factor related to survival 35. However, LN dissection may lead to lymphedema of the legs, nerve damage and lymphocyst formation in 14-32% of patients.…”

Section: Discussionmentioning

confidence: 99%

TMTP1-modified Indocyanine Green-loaded Polymeric Micelles for Targeted Imaging of Cervical Cancer and Metastasis Sentinel Lymph Node in vivo

Wei

Jiang

et al. 2019

Theranostics

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Metastasis is one of the most threatening aspects of cervical cancer. We developed a method to intraoperatively map the primary tumor, metastasis and metastatic sentinel lymph nodes (SLNs), providing real-time intraoperative guidance in cervical cancer.Methods: TMTP1, a tumor metastasis targeting peptide, was employed to modify the indocyanine green (ICG)-loaded poly (ethylene glycol)- poly (lactic-co-glycolic acid) (PEG-PLGA) micelles. The cervical cancer subcutaneous tumor model and lung metastasis model were established to determine the active targeting of ICG-loaded TMTP1-PEG-PLGA micelles (ITM) for the primary tumor and occult metastasis of cervical cancer. Human cervical cancer HeLa cells engineered by firefly luciferase were injected into the right hocks of BALB/c nude mice to develop the SLN metastasis model. The ITM and control ICG-loaded PEG-PLGA micelles (IM) were injected into the right hind footpads in the SLN metastasis model, and the migration and retention of micelles were recorded under near-infrared fluorescence. K14-HPV16 transgenic mice were also used to detect the image capability of ITM to target cancerous lesions.Results: ITM could actively target imaging of the primary tumor and cervical cancer metastasis. ITM quickly diffused from the injection site to SLNs along lymphatic capillaries and remained in the SLNs for 12 h. Moreover, ITM specifically accumulated in the tumor metastatic SLNs (T-SLNs), which could be successfully distinguished from normal SLNs (N-SLNs).Conclusion: ITM could achieve active targeting of the primary tumor, metastasis and T-SLNs, providing precise and real-time intraoperative guidance for cervical cancer.

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Section: Discussionmentioning

confidence: 99%

TMTP1-modified Indocyanine Green-loaded Polymeric Micelles for Targeted Imaging of Cervical Cancer and Metastasis Sentinel Lymph Node in vivo

Wei

Jiang

et al. 2019

Theranostics

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“…Among these PRFs, PET/CT is the most commonly used for diagnosing pelvic lymph node metastasis, and the values are variable, with the sensitivity ranging from 8.3 to 82% in early uterine cervical cancer [9][10][11][12][13]. The reason for this inconsistent result may be that lymph node metastasis is not an independent behaviour but is affected by a variety of clinicopathological factors, including tumour differentiation, invasion depth of stroma, involvement of the parametrium, and so on [14]. Moreover, Benedetti-Panici reported that parametrial invasion was through direct extension in 37% of cases, by lymph node metastases in 59% and LVSI in 52% [15,16].…”

Section: Introductionmentioning

confidence: 99%

The feasibility of 18F-FDG PET/CT for predicting pathologic risk status in early-stage uterine cervical squamous cancer

et al. 2020

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Background Postoperative pathologic risk factors (PRFs) could increase the recurrence rate in early-stage uterine cervical squamous cancer (ECSC). Our study intended to explore the efficiency of 18F-FDG PET/CT for assessing the pathologic risk status (PRS) in ECSC patients. Methods This retrospective study was performed in 240 ECSC patients with stage IA2-IIA2 (FIGO 2009), who underwent preoperative PET/CT scans and subsequent radical surgery between January 2010 and July 2015. Intermediate-risk (tumour diameter ≥ 4 cm, stromal invasion depth ≥ 1/2, lymphovascular space invasion (LVSI)), and high-risk factors (parametria involvement, positive surgery margin, pelvic lymph node metastasis) were confirmed by postoperative pathology. Patients with none of these PRFs were at a low risk for relapse. One of these PRFs was defined as positive risk. The relationship between each PRF and 18F-FDG uptake was analysed by t-test. Chi-square tests and logistic regression analyses were used to determine the efficiency of PET/CT parameters for assessing the PRS. The area under the curve (AUC) was used as an indicator for predictive efficiency. Results Patients with higher SUVmax (p < 0.001), MTV (p < 0.001) and TLG (p < 0.001) had larger tumour sizes and deeper stromal invasion. Further multivariate analyses showed SUVmax and TLG were independent predictors for positive- and intermediate-risk status. In high-risk group, MTV and TLG were associated with pelvic lymph node metastasis and parametria involvement. However, only MTV was a significant indicator. Conclusions Preoperative 18F-FDG PET/CT had an independent predictive value for PRS in ECSC.

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“…Lymph node (LN) metastasis is an important factor affecting survival rate and recurrence. LN metastasis seriously affects treatment and prognosis of cervical cancer (2). In 2018, the latest FIGO staging criteria reclassified LN metastases, indicating that all cases with LN metastasis are classified as stage IIIC (3).…”

Section: Introductionmentioning

confidence: 99%

Application of apparent diffusion coefficient values derived from diffusion-weighted imaging for assessing different sized metastatic lymph nodes in cervical cancers

Zhang

Song

et al. 2019

Acta Radiol

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Background Lymph nodes metastasis is an important factor affecting survival rate and recurrence in cervical cancer patients. Currently, diagnosis of metastatic lymph nodes is mainly based on morphological changes on imaging. However, it is difficult to differentiate normal-sized metastatic lymph nodes with short axis of 5-10mm. Purpose To assess the diagnostic value of apparent diffusion coefficient (ADC) for discriminating different-sized metastatic lymph nodes in patients with cervical cancers. Material and Methods Pathologically confirmed cervical cancer patients were documented from January 2013 to July 2018 in our hospital. A total of 133 patients who underwent conventional MRI and diffusion-weighted imaging with complete pathology were finally enrolled. A total of 157 lymph nodes were harvested and analyzed. All lymph nodes were divided into three groups according to pathology and their short axis (S) measured on axial T2-weighted imaging: normal-sized (5 mm<S<10 mm) benign lymph nodes (Group 1); normal-sized (5 mm<S<10 mm) metastatic lymph nodes (Group 2); enlarged (S≥10 mm) metastatic lymph nodes (Group 3). Mean ADC (ADCmean), minimum ADC (ADCmin), and maximum ADC (ADCmax) values of lymph nodes were analyzed and compared among the three groups. Results ADCmean of Groups 1 and 2 were significantly larger than those of Group 3 ( P<0.001, P=0.005, respectively). ADCmin of Group 1 were significantly larger than those of Groups 2 and 3 ( P<0.001, P<0.001, respectively). ADCmax was not statistically different among the three groups. ADCmean had the relatively highest area under the curve (AUC) of 0.644 for assessing enlarged metastatic lymph nodes, with a sensitivity of 64.4% and specificity of 67.9%. ADCmin had the highest AUC of 0.758 for assessing normal-sized metastatic lymph nodes, with a sensitivity of 84.7% and specificity of 60.7%. Conclusion Diffusion-weighted imaging can be used to differentiate enlarged metastatic lymph nodes from benign lymph nodes, and ADCmin can be further used to identify micro-metastasis in normal-sized lymph nodes.

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Lymph nodes metastasis in cervical cancer: Incidences, risk factors, consequences and imaging evaluations

Abstract: Lymphatic metastasis was significantly related to the clinico pathologic characters and survival of cervical cancer. More sensitive preoperative evaluation is needed for predicting the LN metastasis.

Cited by 35 publications

References 33 publications

TMTP1-modified Indocyanine Green-loaded Polymeric Micelles for Targeted Imaging of Cervical Cancer and Metastasis Sentinel Lymph Node in vivo

TMTP1-modified Indocyanine Green-loaded Polymeric Micelles for Targeted Imaging of Cervical Cancer and Metastasis Sentinel Lymph Node in vivo

The feasibility of 18F-FDG PET/CT for predicting pathologic risk status in early-stage uterine cervical squamous cancer

Application of apparent diffusion coefficient values derived from diffusion-weighted imaging for assessing different sized metastatic lymph nodes in cervical cancers

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