scholarly journals EPV082/#511 Routine pelvic lymph node frozen section examination in preventing ineffective dual modality management in early-stage cervical cancer

2021 ◽  
Author(s):  
C Pappa ◽  
S Smyth ◽  
H Jiang ◽  
C Johnson ◽  
M Mccole ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Early Stage ◽  
Frozen Section ◽  
Pelvic Lymph Node ◽  
Dual Modality ◽  
Frozen Section Examination ◽  
Early Stage Cervical Cancer

Frozen section examination of sentinel lymph nodes can be used as a decisional tool in the surgical management of early cervical cancer

2020 ◽  
Vol 30 (3) ◽  
pp. 358-363 ◽  
Author(s):  
Agnieszka Rychlik ◽  
Martina Aida Angeles ◽  
Federico Migliorelli ◽  
Sabrina Croce ◽  
Eliane Mery ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Early Stage ◽  
Frozen Section ◽  
Lymph Node Involvement ◽  
Stage Iiic ◽  
Frozen Section Examination ◽  
Early Stage Cervical Cancer ◽  
Node Involvement ◽  
The Impact

IntroductionSentinel lymph node (SLN) detection has been shown to be accurate in detecting lymph node involvement in early-stage cervical cancer. The objective of this study was to evaluate the accuracy of frozen section examination in the assessment of SLN status, with the aim of adequately driving the intra-operative decision.MethodsWe designed a retrospective study including patients from two comprehensive cancer centers between January 2001 and December 2018 with early-stage cervical cancer (IA1-IB2 according to International Federation of Gynecology and Obstetrics (FIGO) 2018) undergoing SLN dissection. The SLN procedure was performed using a cervical injection with technetium-99m combined with blue dye or indocyanine green in most cases.ResultsA total of 176 patients fulfilled inclusion criteria. Bilateral mapping was detected in 153 (86.7%) of them. Nineteen of these patients (12.4%) had SLN involvement: 13 with macrometastases, three with micrometastases and three with isolated tumor cells (ITC). Macrometastatic disease was missed on frozen section in 3/13 FIGO 2018 stage IIIC patients. The three patients with ITC were also missed by frozen section examination.Considering only macrometastases as lymph node involvement, frozen section sensitivity was 76.9% (95% CI 49.7 to 91.8) and negative predictive value (NPV) was 97.9% (95% CI 94.0 to 99.3) in patients with bilateral detection. Including micrometastases, sensitivity was 81.2% (95% CI 57.0 to 93.4) and NPV remained at 97.9% (95% CI 93.9 to 99.3).ConclusionsWith a prevalence of final-stage IIIC in patients with pre-operative early-stage cervical cancer of the order of 10% in this series, the NPV of frozen section examination of SLN is very high, with an inferior limit of the CI superior to 94%. Diagnostic accuracy remains acceptable even if micrometastases are considered. The impact of missed ITC has not been established. Frozen section examination can be incorporated in the intra-operative decision algorithm.

scholarly journals Routine Intraoperative Frozen Section Examination to Minimize Bimodal Treatment in Early-Stage Cervical Cancer

2016 ◽  
Vol 26 (6) ◽  
pp. 1148-1153 ◽  
Author(s):  
Phanedra K. Gubbala ◽  
Alexandros Laios ◽  
Zhe Wang ◽  
Sunanda Dhar ◽  
Pubudu J. Pathiraja ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Early Stage ◽  
Frozen Section ◽  
Gynecological Cancer ◽  
False Negative ◽  
Low Risk ◽  
Nodal Disease ◽  
Intraoperative Frozen Section ◽  
Frozen Section Examination ◽  
Early Stage Cervical Cancer

ObjectiveIn early-stage cervical cancer, single modality therapy is the main objective, to minimize patient morbidity while offering equivalent cure rates. Intraoperative frozen section examination (FSE) of lymph nodes (LNs) can facilitate this aim, ensuring that radical surgery is avoided in patients requiring adjuvant therapy for metastatic LN involvement. We aimed to evaluate the accuracy of routine intraoperative FSE of pelvic LNs during the surgical staging of early-stage cervical cancers and identify a group at low risk for nodal metastases.MethodsA retrospective cohort study of 94 women aged 23 to 80 years who underwent primary surgery and planned intraoperative FSE of the pelvic LNs at the gynecological cancer center in Oxford was performed. The diagnostic value of FSE and the prediction of metastatic nodal disease were assessed by use of preoperative and intraoperative variables.ResultsA total of 1825 LNs were submitted for FSE. Of 94 women (13.8%), 13 had positive LNs at FSE. Two false-negative cases were reported with micrometastases but no false-positive cases. Frozen section examination as a diagnostic test reached a sensitivity of 86.7% and a specificity of 100%. A regression model including grade I to II and tumor size of less than 20 mm identified a low-risk group for LN involvement.ConclusionsIn light of diverse practice patterns, FSE should be routinely offered to women with early-stage cervical cancer in a 1-step protocol. We equally devised a model to predict those patients at least risk of nodal disease, who may be spared of FSE.

scholarly journals Lymph Node Involvement in Early-Stage Cervical Cancer: Is Lymphangiogenesis a Risk Factor? Results from the MICROCOL Study

Cancers ◽  
2022 ◽  
Vol 14 (1) ◽  
pp. 212
Author(s):  
Matteo Tantari ◽  
Stefano Bogliolo ◽  
Matteo Morotti ◽  
Vincent Balaya ◽  
Florent Bouttitie ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Risk Factor ◽  
Lymph Node ◽  
Early Stage ◽  
Lymphatic Vessels ◽  
Disease Free Survival ◽  
Lymph Node Involvement ◽  
Pelvic Lymph Node ◽  
Primary Tumors ◽  
Early Stage Cervical Cancer

Background: In patients with cervical cancer, the presence of tumoral lymph-vascular space invasion (LVSI) is the main risk factor for pelvic lymph node metastasis (PLNM). The objective of this study was to evaluate the presence of several markers of lymphangiogenesis in early-stage cervical cancer and their correlation with PLNM and tumoral recurrence. Materials and Methods: Seventy-five patients with early-stage cervical carcinoma underwent sentinel lymph node (SLN) sampling in association with complete pelvic lymph node dissection. Primary tumors were stained with the following markers: Ki67, D2-40, CD31 and VEGF-C. A 3-year follow-up was performed to evaluate the disease-free survival. Results: Overall, 14 patients (18.6%) had PLNM. Positive LVSI was seen in 29 patients (38.6%). There was a significant correlation between LVSI evidenced by H/E staining and PLNM (p < 0.001). There was no correlation between high Ki67, CD31, D2-40, and VEGF-C staining with PLNM or tumor recurrence. Conclusions: Our data support that lymphatic spread does not require the proliferation of new lymphatic endothelial cells in early-stage cervical cancer. These results emphasize the importance of pre-existing peritumoral lymphatic vessels in the metastatic process in early cervical cancer. None of the markers of lymphangiogenesis and proliferation assessed in this study were predictive of PLNM or recurrence.

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