Scalene node biopsy in primary and recurrent invasive carcinoma of the cervix

Abstract

Since June 1971, it has been the policy of the Walter Reed Army Medical Center's Gynecologic Oncology Service to biopsy the left scalene fat pad in two groups of patients presenting with carcinoma of the cervix: (1) primary cases with biopsy-proven metastatic involvement to high common iliac or paraaortic lymph nodes, and (2) all recurrent cases being considered for pelvic exenteration. From June 1971 through June 1979, 43 patients met these criteria for left scalene biopsy. Ten patients had primary disease and 33 had recurrent pelvic carcinoma. Three of ten patients, or 30%, with primary cervical carcinoma had positive left scalene biopsies. All 10 patients had clinically negative supraclavicular examinations. The 3 patients with positive scalene biopsy also had positive paraaortic lymph nodes. However, 4 patients with negative scalene biopsies also had positive aortic lymph nodes. Fourteen of the thirty-three patients with recurrent pelvic carcinoma had positive left scalene node biopsies. Eight of these fourteen were clinically positive, but the other 6 were clinically negative. Therefore, 6 of 25 patients, or 24%, with recurrent cervical carcinoma and clinically negative supraclavicular areas, had metastatic tumor present in the left scalene lymph nodes. In order that patients with widespread carcinoma of the cervix do not receive inappropriate treatment, we recommend scalene node biopsies for the following groups of patients: (1) all primary diagnosed patients with biopsy-proven positive paraaortic lymph nodes; (2) all patients with recurrent carcinoma who are being considered for a pelvic exenteration; and (3) all patients with primary or recurrent disease who have palpable supraclavicular masses.