Sentinel lymph node status in patients with locally advanced cervical cancers and impact of neoadjuvant chemotherapy

Objectives. Neoadjuvant chemotherapy (NAC) is used in locally advanced cervical cancers with the aim to decrease the size of the tumor and to allow for less radical surgery. Despite of the fact that the high response rate of the tumor has been well established, the impact of NAC on sentinel lymph node (SN) detection and status has not been explored to date.Methods. Our study included 82 patients with locally advanced cervical cancers (FIGO IB1 > 3 cm, IB2, IIA2 and selected IIB) out of which 51 patients were referred to SN biopsy prior to NAC and 31 patients to radical surgical procedure including SN biopsy after three courses of “dose density” NAC. In both groups, the prevalence of macrometastases, micrometastases and isolated tumor cells (ITC) in SN was compared.Results. The total of 179 SNs was evaluated. SN detection rate in the whole cohort reached 87.8% per patient and 60.9% bilaterally, without significant difference between both groups. In the group with upfront SN biopsy prior to NAC the prevalence of macrometastases, micrometastases and ITC amounted to 43.1% (22/51), 7.8% (4/51) and 7.8% (4/51) respectively. In the group with SN biopsy after previous NAC, macrometastases were detected in 22.6 (7/31) of patients in SN, whereas there was only one micrometastasis and no ITC detected in that group.Conclusions. Neoadjuvant chemotherapy did not influence the detection rate of SNs, yet it was associated with significantly reduced prevalence of metastatic involvement of SNs, especially almost completely eliminating low volume disease.     

Systematic comparison of radical vaginal trachelectomy and radical hysterectomy in the treatment of early-stage cervical cancer

Objective

To review the effects of radical vaginal trachelectomy (RVT) and radical hysterectomy (RH) on overall progression-free survival rate, and intraoperative and postoperative complications in patients with cervical cancer (FIGO stage IA-IB1).

Methods

Electronic searches for studies of RVT and RH in the treatment of cervical cancer between 1994 and January 2010 were made on MEDLINE, the Cochrane Library, the China National Knowledge Infrastructure, and the Wan Fang dissertation database.

Results

No significant differences were found between RVT and RH in 5-year overall survival rate (relative risk [RR] 0.97; 95% confidence interval [CI], 0.93-1.02); 5-year progression-free survival rate (RR 0.99; 95% CI, 0.95-1.02); intraoperative complications (RR 1.99; 95% CI, 0.61-6.52)]; and postoperative complications (RR 0.36; 95% CI, 0.10-1.27). There were fewer blood transfusions (RR 0.33; 95% CI, 0.12-0.90), less blood loss, and shorter hospital stays in patients undergoing RVT.

Conclusion

Radical vaginal trachelectomy should be considered as a viable treatment option for young patients with early cervical cancer (FIGO stage IA-IB1) who wish to preserve their fertility.     

A postoperative scoring system for distant recurrence in node-positive cervical cancer patients after radical hysterectomy and pelvic lymph node dissection with para-aortic lymph node sampling or dissection

Objective

To identify risk factors for distant recurrence in node-positive cervical cancer patients who underwent radical hysterectomy and pelvic lymph node dissection (PLND) with para-aortic lymph node sampling (PALNS) or para-aortic lymph node dissection (PALND).

Reproductive outcomes of patients undergoing radical trachelectomy for early-stage cervical cancer

Objective

To report the reproductive outcomes of patients undergoing fertility-preserving radical trachelectomy (RT) for the treatment of early-stage cervical cancer.

Methods

We analyzed data from our institution's first 105 patients who underwent attempted fertility-sparing surgery with radical trachelectomy, pelvic lymphadenectomy, and cerclage from November 2001 to October 2010.

Results

Of the 105 patients who underwent attempted RT, 77 (73%) did not require a conversion to radical hysterectomy or postoperative treatment. The median age was 32 (range, 25-38 years). Most patients (75%) had stage IB1 disease. Sixty-six patients (63%) were nulliparous. Thirty-five women were actively attempting conception 6 months after surgery, and 23 (66%) women were successful in conceiving: there were 20 live births, 3 elective terminations, and 4 spontaneous miscarriages. Four patients had 2 pregnancies each; all delivered their second pregnancy between 32 and 36 weeks. Cerclage erosion through the vaginal wall occurred in 6 cases and was treated by transvaginal removal of protruding suture material. One of these patients experienced a second trimester miscarriage.

Conclusions

The majority of women who attempted to conceive after radical trachelectomy were successful, and most of their pregnancies resulted in full-term births. Assisted reproduction played an important role in select women. Cerclage likely contributed to a post-trachelectomy uterine ability to carry a pregnancy to the third trimester. The second post-trachelectomy pregnancy appears to be at higher risk for preterm delivery than the first pregnancy.     

Evaluation of patients after extraperitoneal lymph node dissection for cervical cancer

OBJECTIVE: The presence of nodal metastases is an important prognostic factor in patients with cervical cancer. To adjust our therapy to the anatomic extent of the disease, we performed a surgical staging with extraperitoneal lymph node dissection (EPLND). The goal of our study was to evaluate the clinical outcome and side effects of the combined treatment approach of EPLND and either radical hysterectomy in case of early stage cervical cancer (FIGO Ia/b and IIa) and negative nodes, or pelvic radiotherapy/extended field radiotherapy with concomitant chemotherapy in case of positive nodes or advanced stage cervical cancer (FIGO IIb, III, and IVa). PATIENTS AND METHODS: Fifty-nine patients with primarily diagnosed invasive cervical cancer underwent EPLND. The value of this procedure as a diagnostic tool for evaluating the extent of disease was determined. Additionally, treatment-related complications and clinical outcomes were monitored. RESULTS: A total of 983 lymph nodes were removed during EPLND (mean 16.7). According to the results of EPLND, radical hysterectomy was abandoned due to histopathologically confirmed lymph node involvement by frozen section in 11 out of 36 patients with early stage cervical cancer (31%). The most common adverse effects directly related to surgery in general (EPLND or combined EPLND and radical hysterectomy) were lymph cysts in seven patients (12%). Only in the group of patients who received EPLND followed by radical hysterectomy, 2 out of 25 patients (8%) developed a severe ileus postoperatively (WHO Grade 3 toxicity). The treatment approach of combined EPLND followed by radio- and chemotherapy was without major complications (WHO Grade 3 or 4 toxicity). After a mean follow up of 28 months (range 6-60), 44 out of 58 patients (one patient lost to follow up) are without evidence of disease (76%), 2 patients have progressive disease (3%), and 12 patients died of their disease (21%). Using Kaplan-Meier analysis, the estimated 5-year overall survival rate for all patients is 64% (SD +/- 9%). Performing the Cox proportional regression analysis, in contrast to clinical FIGO staging (P = 0.24; ns), lymph node involvement was the only significant independent predictor for overall survival (P = 0.04). CONCLUSION: Our data support the approach of pretherapeutic surgical staging by performing EPLND as a diagnostic tool with a low complication rate. This allows an individualized treatment for cervical cancer patients.     

Radical abdominal trachelectomy for cervical malignancies: surgical, oncological and fertility outcomes in 62 patients

Objective

To report our experience of radical abdominal trachelectomy for patients with cervical malignancies.

Methods

We conducted a retrospective review of a prospectively maintained database of patients undergoing fertility-sparing radical abdominal trachelectomy for cervical malignancies at our institution from 04/2004 to 09/2010.

Results

Sixty-four patients with cervical malignancies underwent laparotomy for planned radical abdominal trachelectomy. Two patients needed immediate completion of radical hysterectomy due to unfavorable intraoperative findings. Median age was 29.5 years (range, 11-41). Histology included 8 (12.9%) with adenocarcinoma, 50 (80.65%) with squamous carcinoma, 1 (1.61%) with adenosquamous carcinoma and 3 (4.84%) with botryoid sarcoma. Median number of nodes evaluated was 25 (range, 12-53); Ten (16.13%) patients with pathologic risk factors received adjuvant therapy. Fourteen of 36 IB1 cases had tumor size > 2 cm. No recurrences were observed at a median follow-up of 22.8 months. Five (8.06%) patients developed postoperative cervical stenosis — all occurred before we started to routinely install T-IUDs during the procedure. Thirty-eight patients completed the survey which aimed to understand what factors influenced these patients' reproductive outcomes. For various reasons, only 10 patients attempted to conceive and 2 of them succeeded. One of them delivered by cesarean section after 39 weeks and the other is currently pregnant.

Conclusions

Radical abdominal trachelectomy seems to be a reasonable option for selected patients whose tumors are no larger than 4 cm when conducted by experienced gynecologic oncologists. The main perioperative complication is postoperative cervical stenosis, which could be effectively prevented by installation of a tailed T-IUD during the surgery. Social, familial and physical factors can largely influence the patients' reproductive outcomes. The issues of reproductive concerns and quality of life require further investigation.     

新辅助化疗在保留生育功能宫颈癌手术中的应用

宫颈癌发病年龄呈年轻化趋势,未生育的患者比例逐渐上升。保留生育功能的手术已成为治疗早期宫颈癌的标准手术,但适应证严格,获益人群有限。新辅助化疗可以扩大此类手术的适应证,满足患者保留生育功能的目的,且对妊娠无不良影响。     

宫颈癌新辅助化疗后肿瘤组织嗜银核仁组成区变化的研究

目的　研究宫颈癌新辅助化疗（ｎｅｏａｄｊｕｖａｎｔｃｈｅｍｏｔｈｅｒａｐｙ,ＮＡＣＴ） 前后肿瘤组织内ＡｇＮＯＲ 颗粒计数和形态的变化。方法　３１ 例肿块直径≥４ｃｍ 的Ⅰｂ～Ⅱｂ 期宫颈癌患者给予以顺铂为基础的ＮＡＣＴ,３～４ 周后接受子宫广泛切除术。应用Ｐｌｏｔｏｎ’ｓ 方法检测ＮＡＣＴ 前后ＡｇＮＯＲ 计数和形态变化,同时对其组织学疗效进行评价。结果　宫颈癌ＮＡＣＴ 前ＡｇＮＯＲ 颗粒计数为５．０４ ±０．８３ ,ＮＡＣＴ 后为３．２９ ±０．７６ ,两组有非常显著性差异（ Ｐ ＜０．０１） ;ＮＡＣＴ 后,ＡｇＮＯＲ 颗粒形态发生明显变化,单一型和核仁内型所占比例显著上升（ Ｐ ＜ ０．０１） ;组织学无效组,ＮＡＣＴ 前后ＡｇＮＯＲ 颗粒计数也有非常显著性的差异（ Ｐ ＜ ０．００１） 。结论　新辅助化疗对宫颈癌细胞的增殖具有明显的抑制作用,作为巨大宫颈癌综合治疗的一部分值得提倡     

Neoadjuvant chemotherapy and vaginal radical trachelectomy for fertility-sparing treatment in women affected by cervical cancer (FIGO stage IB-IIA1)

Objectives

The aim of the present report is to support the feasibility and the safety of a new fertility-sparing treatment in young women affected by bulky cervical cancer.

Methods

Between February 2007 and October 2010, seven patients presenting large IB-IIA1 tumors (30-45 mm) were scheduled for conservative treatment. All patients underwent neoadjuvant chemotherapy (NACT) followed by laparoscopic pelvic lymphadenectomy and vaginal radical trachelectomy (VRT).

Results

One patient presented hematological toxicity during NACT (grade 3). All patients showed complete disappearance of tumor (n = 4/7) or partial response (a 50% or more decrease in total tumor size, n = 3/7) to neoadjuvant treatment, and they were all treated with pelvic lymphadenectomy and VRT. Additional treatment (interstitial brachytherapy) was offered to only one woman because of a persistent parametrial tumoral lesion.After a mean follow up of 22 months (range 5-49), no relapse was observed. To date, only one woman in our study attempted to conceive and she is currently pregnant.

Conclusions

Neoadjuvant chemotherapy for fertility sparing treatment is an innovative approach which is potentially quite interesting for many young women affected by bulky cervical cancer. These women, i.e. those with tumors larger than 2 cm (2-5 cm), are traditionally not offered fertility sparing treatment, thus the preliminary data we report here might have a promising impact. Nevertheless, for these patients it may be suitable to use the more radical, and time-tested, conservative surgical approach to allow for a complete and conservative excision of the residual tumor after neoadjuvant treatment.Studies with a larger number of patients and adequate follow-up are required to validate this conservative approach and to define clearly the good indications for this treatment.     

A novel diagnostic criterion for lymph node metastasis in cervical cancer using multi-detector computed tomography

Objectives

The sensitivity of the current 10 mm cut-off diameter that is used to diagnose lymph node (LN) metastasis is too low. This is the first study to develop a new criterion to diagnose LN metastasis in a region-by-region manner using multi-detector computed tomography (MDCT).

Methods

1) The short-axis diameter of the LNs in MDCT images from 1-mm slices obtained immediately prior to surgery was compared with the pathological diagnosis in 78 uterine cervical cancer patients undergoing primary surgery. For the region-by-region analysis, we divided para-aortic and pelvic spaces into 13 regions. 2) In 28 cases in which patients received neoadjuvant chemotherapy (NAC) followed by surgery, we compared MDCT images before and after NAC.

Results

1) The optimal cut-off in the region-by-region analysis was 5 mm, yielding 71% sensitivity and 79% specificity. 2) NAC significantly decreased LN size (p < 0.0001). NAC decreased the number of swollen LN regions (> 5 mm) from 51% (81/158) to 26% (41/158).

Conclusions

The new criterion developed using MDCT could be effective for accurately assessing LN status. It also facilitates the assessment of NAC efficacy regarding the eradication of LN metastases.     

Laparoscopic detection of sentinel lymph nodes followed by lymph node dissection in patients with early stage cervical cancer

OBJECTIVE: The purpose of this study was to investigate the feasibility of sentinel node detection through laparoscopy in patients with early cervical cancer. Furthermore, the results of laparoscopic pelvic lymph node dissection were studied, validated by subsequent laparotomy. METHODS: Twenty-five patients with early stage cervical cancer who planned to undergo a radical hysterectomy and pelvic lymph node dissection received an intracervical injection of technetium-99m colloidal albumin as well as blue dye. With a laparoscopic gamma probe and with visual detection of blue nodes, the sentinel nodes were identified and separately removed via laparoscopy. If frozen sections of the sentinel nodes were negative, a laparoscopic pelvic lymph node dissection, followed by radical hysterectomy via laparotomy, was performed. If the sentinel nodes showed malignant cells on frozen section, only a laparoscopic lymph node dissection was performed. RESULTS: One or more sentinel nodes could be detected via laparoscopy in 25/25 patients (100%). A sentinel node was found bilaterally in 22/25 patients (88%). Histological positive nodes were detected in 10/25 patients (40%). One patient (11%) had two false negative sentinel nodes in the obturator fossa, whereas a positive lymph node was found in the parametrium removed together with the primary tumor. In seven patients (28%), the planned laparotomy and radical hysterectomy were abandoned because of a positive sentinel node. Bulky lymph nodes were removed through laparotomy in one patient, and in six patients only laparoscopic lymph node dissection and transposition of the ovaries were performed. These patients were treated with chemoradiation. In two patients, a micrometastasis in the sentinel node was demonstrated after surgery. Ninety-two percent of all lymph nodes was retrieved via laparoscopy, confirmed by laparotomy. Detection and removal of the sentinel nodes took 55 +/- 17 min. Together with the complete pelvic lymph node dissection, the procedure lasted 200 +/- 53 min. CONCLUSION: Laparoscopic removal of sentinel nodes in cervical cancer is a feasible technique. If radical hysterectomy is aborted in the case of positive lymph nodes, sentinel node detection via laparoscopy, followed by laparoscopic lymph node dissection, prevents potentially harmful and unnecessary surgery.     

Indocyanine green-assisted parametrial dissection during type C1 radical hysterectomy after sentinel lymph node biopsy in early stage cervical cancer

Objectives

The standard treatment for FIGO stage 1B1 cervical cancer is radical hysterectomy (RH) [1]. Indocyanine-green (ICG) is a drug injected within the cervical stroma to detect the sentinel lymph node (SLN) in cervical cancer [2,3]. ICG travels through the lymphatic channels in the lateral parametrium, which results enhanced with green, before reaching the SLNs. This could help identifying the surgical landmarks. The aim of this video is to propose a new approach to perform parametrial dissection as part of RH under the guidance of ICG.

Delivery delay with neoadjuvant chemotherapy for cervical cancer patients during pregnancy: a series of nine cases and literature review

Objective

Treatment of locally invasive cervical cancer diagnosed during pregnancy in women who desire to retain their pregnancy is a major challenge to physicians. Neoadjuvant chemotherapy followed by radical hysterectomy has been reported to be an attractive option to delay delivery until fetal viability has been reached.

Methods

Between 1994 and 2009 9 patients were treated at San Gerardo Hospital (Monza, Italy) for cervical cancer during pregnancy.

Results

FIGO stage was IB1 in four patients and IB2 in five. Tumor diameter ranged between 20 and 70 mm. After neoadjuvant platinum-based chemotherapy partial response was achieved in 5 patients, while 4 had a stable disease. One patient received a second-line chemotherapy during pregnancy due to progressive disease, achieving a partial response. Median duration of therapy delay until cesarean section was 16 weeks. Between 30 and 36 weeks of gestation all patients underwent cesarean section. Piver II radical hysterectomy with pelvic lymphadenectomy was performed. Two children had mild perinatal morbidities and were discharged in good conditions after 14 and 40 days. Three patients received adjuvant therapy for pathological risk factors. Four patients relapsed (44%) and two of them (23%) died because of tumor progression.

Conclusion

During pregnancy, the oncological outcome of cervical cancer patients is similar to non-pregnant ones. Chemotherapy does not seem to affect fetal health and development, even if longer follow-up is required. Therefore, neoadjuvant chemotherapy for the treatment of locally invasive cervical cancer during pregnancy seems to be a reasonable option for delay definitive treatment until fetal viability is obtained.     

巨块型宫颈癌ⅠB2～ⅡB期68例术前全身新辅助化疗的近期疗效观察

目的 探讨术前新辅助化疗对巨块型宫颈癌的近期疗效.方法 选择2001年12月至2004年12月华中科技大学同济医学院附属协和医院初治的经病理确诊的68例ⅠB2～ⅡB期巨块型宫颈癌,采用PVB方案化疗2个疗程后手术,观察近期的疗效.结果 临床近期有效率达75%,手术切除率达100%.术前新辅助化疗可提高手术切除率和症状改善率,化疗后肿瘤直径较化疗前有不同程度的缩小,差异有显著意义（P＜0.05）.所有手术患者均能顺利切除病灶并达到切缘距离病灶1cm以上.结论 术前新辅助化疗可提高宫颈癌的近期疗效,成为治疗该病的一种新手段,具有重要的临床意义.     

Fertility sparing surgery for treatment of early-stage cervical cancer: open vs. robotic radical trachelectomy

Objective

To compare the open versus robotic surgical approaches and provide surgical outcome data on patients who have undergone radical trachelectomy (RT).

Methods

We identified patients who underwent open (ORT) or robotic radical trachelectomy (RRT) between September 2005 and June 2011. Tumor characteristics, perioperative, operative and obstetrical outcomes were analyzed.

Results

Thirty-seven patients with early stage cervical cancer that desired future fertility underwent attempted radical trachelectomy, and 32 patients (20 with 1B1, 11 with 1A2, and 5 with 1A1 with LVSI/poorly differentiated histology) had successful completion of RT. Five (1 open/4 robotic) underwent conversion to radical hysterectomy secondary to close (< 5 mm) endocervical margin (p = 0.08). The median age at diagnosis was 28.9 years (range; 21.4-37.2), 70% were nulliparous, and 9 had a visible lesion. Twenty-five patients (68%) underwent ORT and 12 (32%) underwent RRT. RRT was associated with less blood loss (62.5 mL vs. 300 mL, p = 0.0001) and decreased length of postoperative stay (1 vs. 4 days, p < 0.001), with no difference in operative time or histopathologic outcomes. Twenty-three patients (62%) had no residual cervical disease on final pathology. Common long-term morbidities were irregular menstrual bleeding or amenorrhea (25%), cerclage erosion (13%), or cervical stenosis (9%). Although there was a higher rate of conversion to hysterectomy in the robotic surgery cohort, rates of serious morbidities among the cohorts were comparable (robotic: 33% vs. open: 24%, p = 0.70). Eleven (36%) patients are actively attempting pregnancy and three have achieved pregnancy. The median time of follow up is 17.0 months (range 0.30-64.9 months). There are no documented recurrences.

Conclusions

RRT results in less blood loss and decreased length of hospital stay with no compromise in histopathologic outcomes.     

Lymph node mapping and sentinel node detection in patients with cervical carcinoma: a 2-year experience

OBJECTIVE: To describe our experience with the sentinel lymph node biopsy in cervical cancer patients, using a laparotomic approach and blue dye technique. METHODS: Between January 2003 and January 2005, patients with histologically proven FIGO stage IA2 to IIA carcinoma of the uterine cervix were submitted to SLN procedure if they were scheduled to have radical abdominal hysterectomy and pelvic lymphadenectomy. The SLN mapping was done after intracervical methylene blue (4 ml) injection. Final pathologic evaluation of SLNs included serial step sections and wide spectrum cytokeratin immunohistochemical analysis. RESULTS: Fifty patients were accrued to this prospective observational double-center study. A total of 86 SLNs (mean 1.9) were identified in the 45 patients with fruitful quest for SLN detection. The SLN detection rate per patient was 90%, and for the side of dissection, 72%. Bilateral SLNs were detected in 60% of cases. SLNs were identified in the external iliac and obturator areas in 55% and 38%, respectively; 5 isolated SLNs were discovered in the common iliac region. Ten patients (20%) had lymph node metastases; one of these had false-negative SLN. The false-negative rate and the negative predictive value, calculated by patient and by side of dissection, were 10% and 97.2%, and 8.3% and 98.4%, respectively. CONCLUSIONS: SLN detection with blue dye is a feasible procedure, particularly useful as a surgical staging procedure in young patients with small tumors. The true morbidity-sparing role of this technique in cervical cancer treatment is yet to be found.     

Significance of numbers of metastatic and removed lymph nodes in FIGO stage IB1 to IIA cervical cancer: Primary surgical treatment versus neoadjuvant chemotherapy before surgery

Objective.

The objective of this study was to compare the significance of numbers of metastatic (MLN) and removed lymph nodes (RLN) between primary surgical treatment (PST) and neoadjuvant chemotherapy followed by surgery (NCS) in patients with FIGO stage IB1 to IIA cervical cancer.

Methods.

Among 1124 patients with cervical cancer, PST (n = 451) and NCS (n = 73) groups were enrolled for evaluating the association between numbers of MLN and RLN, and clinical outcomes including the pattern of recurrence and survival according to the 2 treatments.

Results.

Mean values of progression-free survival (PFS) were 100.8 vs. 87.6 vs. 57.7 months in 0 vs. 1-2 vs. ≥ 3 MLN, suggesting that ≥ 3 MLN was associated with poor PFS (adjusted HR, 2.71; 95% CI, 1.02 to 7.21). However, there was no association between the number of MLN and survival in NCS group. The increased number of MLN was also associated with the increase of distant metastasis in PST group (44.0% vs. 72.7% vs. 78.6%; p = 0.02), whereas there was no association between the number of MLN and the pattern of recurrence in NCS group. Moreover, mean values of PFS were 57.2 (< 20 RLN) vs. 77.9 months (≥ 20 RLN) in PST group with lymph node metastasis (p = 0.04), demonstrating that ≥ 20 RLN improved PFS in PST group (adjusted HR, 0.48; 95% CI, 0.25 to 0.95).

Conclusions.

The increased number of MLN may be more significant for predicting poor survival and distant metastasis, and the increased number of RLN may be associated with better survival in the patients treated with PST than those treated with NCS.     

Identification of prognostic factors in patients with cervical cancer and supraclavicular lymph node recurrence

Objective

Patients with cervical cancer and supraclavicular lymph nodes (SLN) recurrence have a poor but heterogeneous prognosis. The aim of this study was to identify potential prognostic factors – including FDG-PET results – that may affect survival and treatment outcomes in patients with this group of patients.

Methods

Between January 2001 and December 2008, we identified a total of 31 consecutive patients with cervical cancer who had evidence of SLN recurrence. All participants underwent FDG-PET. Survival was measured from the date of documented SLN recurrence. The latency period was defined as the length of time from the date of first diagnosis to the date of SLN recurrence.

Results

The median follow-up time was 22.8 months (range: 4.7–105.1). The 3- and 5-year survival rates were 41% and 27.3%, respectively. Patients with intermediate SUV values (between 4.3 and 8) had a significantly better prognosis than subjects with both high (> 8) or low (< 4.3) SUV values (p = 0.004). Latency period < 2 years, SCC-Ag levels ≥ 4 ng/mL, recurrence extend beyond SLN, and SUV of < 4.3 > 8 were significant adverse prognostic factors by multivariate analysis. The 3-year overall survival (OS) rate of patients carrying 0–1 adverse prognostic factors was 90% (low-risk group), while 3-year OS rates for intermediate-risk group (2 factors) and high-risk group (3–4 factors) were 30% and 0%, respectively (p = 0.001).

Conclusion

Our results justify the use of PET (accurate extent of relapse and SUV) as a prognostic tool in patients with cervical cancer and SLN recurrence.     

Laparoscopic identification of sentinel lymph node in treatment of invasive cervical cancer

The fundamental prognostic factor in treatment of early cervical cancer is the state of regional lymph nodes. If the first lymphatic node is involved by cancer, the other ones may be affected; otherwise if the first one is free of metastatic cells, the others should not be involved by cancer either. Detection and removal of the lymphatic node called the sentinel lymph node permit to avoid radical lymphadenectomy which is connected with many severe complications. We reported a technique of identification of the sentinel lymph node during laparoscopic radical hysterectomy with pelvic lymphadenectomy in treatment of early invasive cervical cancer with presentation of case history. Identification of sentinel node with its histopathology examination may be essential in women with cervical cancer and potentially identifies women in whom lymph node dissection can be avoided. Laparoscopic lymphadenectomy seems to be equally effective and less invasive in comparison to traditional technique.