Abstract
Metastases in regional lymph nodes in CC significantly reduces patients' survival. Study demonstrates possibility of molecular diagnosis of metastases in regional lymph nodes. 112 patients with squamous CC IB - IIB stages by FIGO underwent surgical or combined treatment since 1995 to 2008 were enrolled. Distribution of patients by TNM stage: I (T1N0M0) - 32, II (T2N0M0) - 33, III (T1,2N1M0) - 33 patients. All patients were tracked during 36 to 120 months after treatment. High cancerogenic risk HPV DNA in cells of primary tumor derived from endocervical brushstrokes was detected using PCR method with DNA-sorb-A. HPV DNA in cells of iliac lymph nodes removed during surgery and stored in paraffin blocks was detected with PCR. HPV DNA test in primary tumor revealed a prevalence of HPV 16 genotype (in 81 patients - 82.7%), the other: 33 type - 31.7%, 18 -24.5%, 31-10.2%, 56-10.2%, 58-10.2%, 45-9.2%, 39 -5.1%, 52 -5.1%, 51-4.1%, 53-2.0% and 42 type -1.0%. HPV DNA in regional lymph nodes was found in 29 of 98 patients (29.6%) using PCR. In 27 of these 29 patients there were confirmed lymph nodes metastases (93.1% of all patients with lymph node metastases (p ≤ 0.05)). HPV DNA 16 type in lymph nodes was detected in 15 patients (51.7%), 18 type - in 4 (13.8%), 31 - in 5 (17.2%),33 – in 5 (17.2%). In all cases HPV type in lymph nodes matched the type in primary tumor. Identification of HPV DNA in iliac lymph nodes was significantly more consistent with detection of HPV in primary cervical tumors with one HPV type (58.62%) than infection with multiple HPV types (p ≤ 0.05). Method of DNA HPV detection in regional lymph nodes showed its high specificity: 96.9% (95% CI: 89 ÷ 100%) and relatively high sensitivity: 81.8% (95% CI: 65 ÷ 93%) in diagnostics of metastases. Diagnostic efficiency of test was 91.8% (false-negative response -18.2%, false positive - 3.1%). Bilateral (66.7%) metastatic lymph nodes were found more often if HPV type 16 was detected in iliac lymph nodes (p ≤ 0.05). Detection of HPV DNA type 18 was often associated with unilateral metastases (p = 0.014). Method of HPV DNA detection in iliac lymph nodes of patients with CC has high specificity and enough high sensitivity in diagnostics of lymph node metastases including investigation of sentinel lymph nodes.
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