Intraoperative Detection of Lymph Nodes Metastasis in Early-Stage Cervical Cancer

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E. Bravo J Cartagena L. Galdames C. Urbina F. Nuñez I. Bravo A. Lehuede A. Jara R. González


The treatment of early-stage Cervical Cancer consists of Radical Surgery or Radiochemotherapy, both with similar outcomes. Surgical treatment is preferred in young patients to preserve ovarian and sexual function. The combination of both therapies significantly increases risk of complications, so combined treatment should be avoided. Lymph node metastasis is a negative prognosis factor in these patients, forcing adjunctive therapy (radiochemotherapy), therefore, intraoperative metastatic node evaluation is crucial to avoid combined treatment. The present communication analyzes a cohort of patients undergoing radical surgery, with special emphasis on the detection of tumor nodes during lymphadenectomy prior to hysterectomy. Of a total of 170 patients undergoing surgery for early-stage Cervical Cancer, 26 patients (14.1%) had lymph node metastasis, 19 (73%) detected during the surgical act (lymphadenectomy) in contemporary biopsy and 7 (27%) in the postoperative period through final histology. In 12 patients, lymph node involvement is obtained through the sentinel lymph node, intraoperative 9 and 3 in final node biopsy reported as negative in contemporary biopsy. The remaining 10 intraoperative diagnoses were made in the contemporary biopsy due to macroscopic suspicion of tumor involvement. In this case series, the contemporary biopsy of the macroscopically suspicious nodes and sentinel lymph nodes, allowed intraoperative detection of 73% of patients with metastatic node, which spared this group of patients from receiving combined treatment with the consequent increase in risk of complications.

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BRAVO, E. et al. Intraoperative Detection of Lymph Nodes Metastasis in Early-Stage Cervical Cancer. Medical Research Archives, [S.l.], v. 10, n. 5, june 2022. ISSN 2375-1924. Available at: <>. Date accessed: 30 june 2022. doi:
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1) Peters WA III, Liu PY, Barrett RJ II: Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J ClinOncol 2000; 18: 1606-1613
2) Gien LT, Covens A, Lymph Node Assessment in Cervical Cancer: Prognostic and Therapeutic Implications. Journal of Surgical Oncology 2009; 99:242–247
3) D. Cibula, Pötter R, Planchamp F et al. Pathology guidelines for the management of patients with cervical cancer, The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Radiother. Oncol.2018; 127:
4) Dostalek L, Slama J, Fisherova D, et al. Impact of sentinel lymph node frozen section evaluation to avoid combined treatment in early-stage cervical cancer. Int J Gynecol Cancer. 2020; 30(6):744–8.
5) Cibula D, Potter R, Planchamp F, et al. The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology guidelines for the management of patients with cervical cancer. Int J GynecolCancer. 2018; 28(4):641–55.
6) Lee SI, Catalano OA, Dehdashti F. Evaluation of gynecologic cancer with MR imaging, 18F-FDG PET/CT, and PET/MR imaging..J NuclMed. 2015 Mar; 56(3):436-43
7) Van de Lande J, Torrenga B, Reijmakers P et al.Sentinel lymph node detection in early stage uterine cervix carcinoma: a systematic review.GynecolOncol 2007 Sep; 106(3):604-13.DOI: 10.1016/j.ygyno.2007.05.010
8) Colturato LF, Signorini R, Fernandes R et al, Lymph node micrometastases in initial stage cervical cáncer and tumoral recurrence.Int J Gynaecol Obstet 2016 Apr;133(1):69-75.DOI: 10.1016/j.ijgo.2015.08.019
9) Cipolla C, Graceffa G, La Mendola R, The prognostic value of sentinel lymph node micrometastases in patients with invasive breast carcinoma. Ann Ital Chir. 2015; 86:497-502.
10) Cibula D, McCluggage WG, Sentinel lymph node (SLN) concept in cervical cancer: Current limitations and unanswered questions, GynecolOncol2019 Jan;152(1):202-207.
doi: 10.1016/j.ygyno.2018.10.007.
11) Vercellino GF, Erdemoglu E, Lichtenberg P, et al. A GCIG international survey: clinical practice patterns of sentinel lymph node biopsies in cervical cancer. Arch Gynecol Obstet. 2019; 300(1):191–9.

12) Balaya V, Guani B, Pache B et al Sentinel lymph node in cervical cancer: time to move forward. Chin ClinOncol 2021; 10(2):18 |
13) Dostalek L, Runnebaum I, Raspagliesi F et al Oncologic outcome after completing or abandoning (radical) hysterectomy in patients with cervical cancer and intraoperative detection of lymph node positivity; ABRAX (ABandoning RAd hyst in cerviX cancer). Int J Gynecol Cancer 2019; 0:1–4. Doi: 10.1136/ijgc-2019-000890
14) Ester P. Olthof1, Maaike A. van der Aa, Judit A et al The role of lymph nodes in cervical cancer: incidence and identifcation of lymph node metastases—a literature review. International Journal of Clinical Oncology
15) Bats AS, Buénerd A, Querleau D, et al. SENTICOL collaborative group. Diagnostic value of intraoperative examination of sentinel lymph node in early cervical cancer: a prospective, multicenter study. GynecolOncol 2011; 123:230–5.
16) Michel R, Geneviève BF, Ion P et al. Value of sentinel node mapping in cancer of the cervix GynecolOncol2011;122: 269–274 Doi: 10.1016/j.ygyno.2011.04.002
17) J.Slama,P.Dundr,L.Dusek, et al. High false negative rate of frozen section ex- amination of sentinel lymph nodes in patients with cervical cancer, Gynecol. Oncol 2013;129:384–388.
18) Klapdor R, Hillemans P, Wölber L, et al. Outcome after sentinel lymph node dissection in vulvar cancer: a sub- group analysis of the AGO-CaRE-1 study. Ann Surg Oncol. 2017; 24:1314–21.
19) Froeding LP, Høgdall C, Kristensen E, et al. Recurrence and survival rates in node negative patients after sentinel node biopsy for early-stage vulva cancer – a nationwide study. GynecolOncol 2020; 156:124–30.
20) Veronesi U, Paganelli G, Viale G et al. A randomized comparison of sentinel- node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 2003; 349(6):546–53
21) Wong SL, Edwards MJ, Chao C et al. Sentinel lymph node biopsy for breast cancer: impact of the number of sentinel nodes removed on the false-negative rate. J Am Coll Surg. 2001; 192(6):684–9; discussion 689–91.
22) Cibula D. Sentinel Lymph Node Biopsy in Patients with Early Stages Cervical Cancer (SENTIX). Identifier: NCT02494063
23) Jihong Liu. Sentinel Lymph Node Biopsy Versus Pelvic Lymphadenectomy in Early-stage Cervical Cancer (PHENIX/CSEM 010). Identifier: NCT02642471
24) Centre Hospitalier Universitaire de Besancon. International Validation Study of Sentinel Node Biopsy in Early Cervical Cancer (SENTICOLIII). Identifier: NCT03386734
25) Richard S, Krivak T, Castleberry Aet al. Survival for stage IB cervical cancer with positive lymph node involvement: a comparison of completed vs. abandoned radical hysterectomy.GynecolOncol. 2008 Apr; 109(1):43-8. doi: 10.1016/j.ygyno.2007.12.002. Epub 2008 Jan 29.
26) Cibula D, Abu-Rustum NR, Dusek L et al Prognostic significance of low volume sentinel lymph node disease in early-stage cervical cancer, Gynecol. Oncol 2012;124: 496–501.
27) K.Sonoda,H.Yahata,K.Okugawa, et al. Value of intraoperative cytological and pathological sentinel lymph node diagnosis in fertility-sparing trachelectomy for early-stage cervical cancer, Oncology 2018; 94:92–98.
28) Malter W, Hellmich M, Badian M et al Factors Predictive of Sentinel Lymph Node Involvement in Primary Breast Cancer, Anticancer Res 2018 Jun;38(6):3657-3662.