Lymphatic mapping and parametrial lymph nodes identification in patients with early stage cervical cancer

Abstract

5050 Background: The purpose of this study was to determine the presence, distribution, and metastasis incidence of parametrial lymph nodes (PLN) of patients with cervical cancer, and to investigate the role of lymphatic mapping and topographic section in PLN identification. Methods: Sixty patients with early stage (Ib∼IIa) cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy were included in the study. Before surgery 4 ml methylene was injected into the cervix around the tumor. The blue-dyed lymph nodes were identified as sentinel lymph nodes (SLN) during operation. An immediate topographic section on uterine specimen was performed to separate the PLNs from parametria for pathologic examination. Results: Ninety five PLNs were presented in 38 (63.3%) of 60 specimens, with a mean size in diameter as (0.67±0.24)cm, and 57 (60.0%) of PLNs were located parallel to the uterine artery through the entire broad ligament. After lymphatic mapping, 69 (72.6%) of PLNs was dyed and found out as SLNs. Parametrial metastasis was found in 12 (20.0%) patients, and parametrium was the only site containing positive nodes in 2 patients with parametrial metastasis. On routine pathologic evaluation, 17 PLNs were found to be positive. Among the remaining 78 PLNs, multilevel sectioning in conjunction with immunohistochemical analysis was carried out and identified 3 other PLNs containing micrometastases. Conclusions: The study showed that PLNs were often found in the parametria, and these nodes often contained metastatic diseases, which were often overlooked. Lymphatic mapping followed by meticulous topographic section is feasible in PLN identification in patients with cervical cancer. No significant financial relationships to disclose.