What is the risk for parametrial involvement in women with early‐stage cervical cancer with tumour <20 mm and with negative sentinel lymph nodes?

Abstract

Aims: To evaluate the incidence of parametrial involvement in women with early-stage cervical cancer with tumour <20 mm and with negative sentinel lymph nodes (SLN). Methods: We reviewed the cases of all women who underwent radical hysterectomy and pelvic lymphadenectomy with SLN biopsy for invasive cervical cancer between April 2004 and December 2009. Parametrial involvement was defined as direct extension, nodal disease or spread through vascular channels. Results: From the 204 women who underwent radical surgery with SLN biopsy, 63 (FIGO stage IA2-10, IB1-53) met the inclusion criteria: tumour <20 mm in the largest diameter regardless of the depth of stromal invasion (less or more than half stromal invasion) and negative sentinel lymph nodes. Median age was 44.3 years (range 24-72). Lymph-vascular space invasion was present in 25 women. The histology identified squamous carcinoma in 50 women, adenocarcinoma in 11 women and adenosquamous carcinoma in two women. Tumour grade 1 occurred in 41, grade 2 in 16 and grade 3 in 6 of the cases. No parametrial involvement was observed. The false negative rate of SLN biopsy was 0%. Conclusion: No parametrial involvement was observed in women with early-stage cervical cancer with tumour <20 mm in diameter and negative sentinel lymph nodes regardless of the presence of lymph-vascular space invasion, histology subtype and grade of the tumour. Radical removal of the parametrium in this low-risk group is questionable.

Clinical and pathological characteristics related to parametrial involvement in clinical early-stage cervical cancer

“…Likewise, Klat et al, reported 204 patients who underwent radical surgery with SLN biopsy. They found no subjects with parametrial involvement among women with early-stage cervical cancer, with tumor < 20 mm in diameter and negative sentinel lymph nodes [17]. Our findings are consistent with those of Covens et al, who also detected a correlation between tumor size, LVSI, greater depth of invasion, and positive pelvic lymph nodes with parametrial involvement.…”

Risk Factors for Parametrial Involvement in Early-Stage Cervical Cancer and Identification of Patients Suitable for Less Radical Surgery

“…They also found that the obturator lymph nodal group was generally the first and the most common site of tumor metastasis. Several authors have included negative pelvic lymph nodes as an inclusion criterion for a low-risk subgroup [4,5,7,11,26,27]. Assessment of this as a risk factor, of course, requires knowing the pelvic lymph node status, and sentinel lymph node (SLN) biopsy has been extensively described for the assessment of the pelvic lymph nodes in cervical cancer.…”

“…However, accurate SLN analysis requires coordinated efforts by a multidisciplinary team [6]. Less radical surgery in SLN-negative patients with small tumor volume is still experimental [26,27]. …”

Sentinel node biopsy for lymph nodal staging of uterine cervix cancer: A systematic review and meta-analysis of the pertinent literature

“…Strnad et al and Klat et al separately showed that patients with negative sentinel nodes do not have pathological parametrial involvement. 99,100 Although the pooled sensitivity of sentinel node mapping in fertility-sparing surgery was high, readers should be very cautious when interpreting the results. The number of studies are limited in this regard and the accuracy of frozen section is highly debated in cervical cancer sentinel node biopsies.…”