1
|
Kocian R, Kohler C, Bajsova S, Jarkovsky J, Zapardiel I, Di Martino G, van Lonkhuijzen L, Sehnal B, Sanchez OA, Gil-Ibanez B, Martinelli F, Presl J, Minar L, Pilka R, Kascak P, Havelka P, Michal M, van Gorp T, Nemejcova K, Dundr P, Cibula D. Sentinel lymph node pathological ultrastaging: Final outcome of the Sentix prospective international study in patients with early-stage cervical cancer. Gynecol Oncol 2024; 188:83-89. [PMID: 38941963 DOI: 10.1016/j.ygyno.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/15/2024] [Accepted: 06/23/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVE To report the outcome of SLN staging in the SENTIX international prospective trial of SLN biopsy in patients with cervical cancer with an intensive ultrastaging protocol and central quality control and to evaluate how the intensity of pathological assessment correlates with metastatic detection rate in SLNs. METHODS Eligible were patients with stages T1a1/LVSI+ to T1b2 (<4 cm, ≤2 cm for fertility sparing), common tumor types, no suspicious lymph nodes on imaging, and bilateral SLN detection. SLNs were examined intraoperatively and processed by an intensive protocol for ultrastaging (paraffin blocks sectioned completely in 150-μm intervals/levels). SLNs from each site were submitted for central quality control. RESULTS In the SENTIX SLN study, 647 out of 733 enrolled patients underwent SLN ultrastaging, identifying 12.5% (81/647) with node positive, N1 cases. Intraoperative detection revealed metastases in 56.8% (46/81) of these cases, categorized into macrometastases (83.7%), micrometastases (26.3%), and isolated tumor cells (9.1%). Ultrastaging identified additional metastatic involvement in 43.2% (35/81) of patients, with detailed sectioning revealing metastases (MAC/MIC) at first level in 20 cases (24.7%), at levels 2-4 in 9 cases (11.1%), and at level ≥5 in 6 cases (7.4%). CONCLUSION SLN ultrastaging detects additional 43% of N1 (MAC/MIC) in patients with negative LNs by imaging and intraoperative pathological assessment. The detection rate of positive SLN correlates with the intensity (number of levels) of ultrastaging. Examination of four levels from paraffin blocks, which detects >90% of patients with N1, is a reasonable compromise for an international standard for ultrastaging. STUDY REGISTRATION NCT02494063 (ClinicalTrials.gov).
Collapse
Affiliation(s)
- Roman Kocian
- Gynecologic Oncology Center, Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
| | - Christhardt Kohler
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, Hamburg, Germany
| | - Sylva Bajsova
- Department of Obstetrics and Gynecology, University Hospital Ostrava, Ostrava, Poruba, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ignacio Zapardiel
- Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - Giampaolo Di Martino
- Gynecologic Oncology Surgical Division, Humanitas San Pio X, Milan, 20159, Italy; Gynecology Unit, IRCCS Fondazione San Gerardo dei Tintori, 20900, Monza, Italy
| | - Luc van Lonkhuijzen
- Center for Gynecologic Oncology, Academic Medical Centre, Amsterdam, Netherlands
| | - Borek Sehnal
- Department of Obstetrics and Gynecology, University Hospital Bulovka, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Octavio Arencibia Sanchez
- Department of Gynecologic Oncology, University Hospital of the Canary Islands, Las Palmas de Gran Canaria, Spain
| | - Blanca Gil-Ibanez
- Unit of Gynecological Oncology, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona, Barcelona, Spain
| | - Fabio Martinelli
- Department of Gynecological Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy; Gynecologic Oncology Surgical Division, Humanitas San Pio X, Milan, 20159, Italy
| | - Jiri Presl
- Department of Gynaecology and Obstetrics, University Hospital Pilsen, Charles University, Prague, Czech Republic
| | - Lubos Minar
- Department of Gynecology and Obstetrics, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Radovan Pilka
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc, Olomouc, Czech Republic
| | - Peter Kascak
- Department of Obstetrics and Gynecology, Faculty Hospital Trencin, Trencin, Slovakia
| | - Pavel Havelka
- Department of Obstetrics and Gynecology, KNTB a.s, Zlin, Czech Republic
| | - Martin Michal
- Department of Obstetrics and Gynaecology, Hospital Ceske Budejovice, JSC, Ceske Budejovice, Czech Republic
| | - Toon van Gorp
- Department of Gynecology and Obstetrics, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Kristyna Nemejcova
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pavel Dundr
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - David Cibula
- Gynecologic Oncology Center, Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| |
Collapse
|
2
|
Moretti-Marques R, Franca IB, de Cillo PE, Alvarenga-Bezerra V, Helito JK, Filho DC, Kim NJ, Ribeiro R. First birth after uterine transposition in low-volume lymph node metastasis of cervical cancer: A long journey for success. J Surg Oncol 2024. [PMID: 39138911 DOI: 10.1002/jso.27805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 07/25/2024] [Accepted: 08/02/2024] [Indexed: 08/15/2024]
Abstract
Locally advanced cervical cancer poses a significant challenge to fertility-sparing treatments. Pelvic radiotherapy impairs reproductive potential owing to ovarian, uterine, and endometrial side effects. This study presents a literature review of the main fertility-sparing therapeutic alternatives for locally advanced cervical cancer and a case report of the first childbirth following uterine transposition for gynecological malignancies.
Collapse
Affiliation(s)
- Renato Moretti-Marques
- Department of Gynecological Oncology, Hospital Israelita Albert Einstein, Sao Paulo City, Sao Paulo, Brazil
| | - Ive Bahia Franca
- Department of Gynecological Oncology, Hospital Israelita Albert Einstein, Sao Paulo City, Sao Paulo, Brazil
| | - Pedro Ernesto de Cillo
- Department of Gynecological Oncology, Hospital Israelita Albert Einstein, Sao Paulo City, Sao Paulo, Brazil
| | - Vanessa Alvarenga-Bezerra
- Department of Gynecological Oncology, Hospital Israelita Albert Einstein, Sao Paulo City, Sao Paulo, Brazil
| | - Juliana Karassawa Helito
- Department of Gynecological Oncology, Hospital Israelita Albert Einstein, Sao Paulo City, Sao Paulo, Brazil
| | - Donato Callegaro Filho
- Department of Gynecological Oncology, Hospital Israelita Albert Einstein, Sao Paulo City, Sao Paulo, Brazil
| | - Nam Jin Kim
- Department of Gynecological Oncology, Hospital Israelita Albert Einstein, Sao Paulo City, Sao Paulo, Brazil
| | - Reitan Ribeiro
- Department of Gynecological Oncology, Hospital Erasto Gaertner, Curitiba, Brazil
| |
Collapse
|
3
|
Śniadecki M, Guani B, Jaworek P, Klasa-Mazurkiewicz D, Mahiou K, Mosakowska K, Buda A, Poniewierza P, Piątek O, Crestani A, Stasiak M, Balaya V, Musielak O, Piłat L, Maliszewska K, Aristei C, Guzik P, Wojtylak S, Liro M, Gaillard T, Kocian R, Gołąbiewska A, Chmielewska Z, Wydra D. Tertiary prevention strategies for micrometastatic lymph node cervical cancer: A systematic review and a prototype of an adapted model of care. Crit Rev Oncol Hematol 2024; 197:104329. [PMID: 38527594 DOI: 10.1016/j.critrevonc.2024.104329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/29/2024] [Accepted: 03/12/2024] [Indexed: 03/27/2024] Open
Abstract
PURPOSE We found a need for balancing the application of clinical guidelines and tailored approaches to follow-up of cervical cancer (CC) patients in the lymph node micrometastatic (MICs) setting. This review aimed to determine the current knowledge of management of MIC-positive CC cases. METHODOLOGY We addressed prognostic and risk of recurrence monitoring impacts associated with MIC+ cases. The electronic databases for literature and relevant articles were analysed. RESULTS Fifteen studies, (4882 patients), were included in our systematic review. While the results show that MICs significantly worsen prognosis in early CC. A tertiary prevention algorithm for low volume lymph node disease may stratify follow-up according to the burden of nodal disease and provide data that helps improve follow-up performance. CONCLUSION MICs worsen prognosis and should be managed as suggested by the algorithm. However, this algorithm must be externally validated. The clinical impact of isolated tumor cells (ITC) remains unclear.
Collapse
Affiliation(s)
- Marcin Śniadecki
- Department of Gynaecology and Obstetrics, Medical University of Gdańsk, Gdańsk, Poland.
| | - Benedetta Guani
- Hospital of Fribourg HFR, Chemin des Pensionnats 2/6, Villars-sur-Glâne 1752, Switzerland
| | - Paulina Jaworek
- Department of Gynaecology and Obstetrics, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Katia Mahiou
- Breast, Gynaecology and Reconstructive Surgery Unit, Institute Curie, Paris, France
| | - Karolina Mosakowska
- Department of Gynaecology and Obstetrics, Medical University of Gdańsk, Gdańsk, Poland
| | - Alessandro Buda
- Department of Gynaecology Oncology, Michele e Pietro Ferrero Hospital, Verduno, Italy
| | | | - Olga Piątek
- Department of Gynaecology and Obstetrics, Medical University of Gdańsk, Gdańsk, Poland
| | - Adrien Crestani
- Department of Gynaecological Surgery, Hospital Tenon, Paris, France
| | - Maria Stasiak
- Department of Gynaecology and Obstetrics, Medical University of Gdańsk, Gdańsk, Poland
| | - Vincent Balaya
- Department of Obstetrics and Gynaecology, Félix Guyon Hospital, CHU La Réunion, La Reunion Island, France
| | - Oliwia Musielak
- Department of Surgical Oncology, Transplant and General Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Luiza Piłat
- Department of Gynaecology and Obstetrics, Medical University of Gdańsk, Gdańsk, Poland
| | - Karolina Maliszewska
- Department of Gynaecology and Obstetrics, Medical University of Gdańsk, Gdańsk, Poland
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Sant'Andrea delle Fratte, Perugia, Italy
| | - Paweł Guzik
- Clinical Department of Gynaecology and Obstetrics, City Hospital Rzeszów, Rzeszów, Poland
| | - Szymon Wojtylak
- Department of Pathology, Medical University of Gdańsk, Gdańsk, Poland
| | - Marcin Liro
- Department of Gynaecology and Obstetrics, Medical University of Gdańsk, Gdańsk, Poland
| | - Thomas Gaillard
- Department of Surgery, Institute Curie, University Paris Cite, Paris, France
| | - Roman Kocian
- Department of Gynaecology, Obstetrics and Neonatology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Anna Gołąbiewska
- Department of Environmental Technology, Faculty of Chemistry, University of Gdańsk, Gdańsk, Poland
| | - Zuzanna Chmielewska
- Department of Gynaecology and Obstetrics, Medical University of Gdańsk, Gdańsk, Poland
| | - Dariusz Wydra
- Department of Gynaecology and Obstetrics, Medical University of Gdańsk, Gdańsk, Poland
| |
Collapse
|
4
|
Nitecki R, Ramirez PT, Dundr P, Nemejcova K, Ribeiro R, Vieira Gomes MT, Schmidt RL, Bedoya L, Isla DO, Pareja R, Rendón Pereira GJ, Lopez A, Kushner D, Cibula D. MILACC study: could undetected lymph node micrometastases have impacted recurrence rate in the LACC trial? Int J Gynecol Cancer 2023; 33:1684-1689. [PMID: 37652529 DOI: 10.1136/ijgc-2023-004711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVE The etiology of inferior oncologic outcomes associated with minimally invasive surgery for early-stage cervical cancer remains unknown. Manipulation of lymph nodes with previously unrecognized low-volume disease might explain this finding. We re-analyzed lymph nodes by pathologic ultrastaging in node-negative patients who recurred in the LACC (Laparoscopic Approach to Cervical Cancer) trial. METHODS Included patients were drawn from the LACC trial database, had negative lymph nodes on routine pathologic evaluation, and recurred to the abdomen and/or pelvis. Patients without recurrence or without available lymph node tissue were excluded. Paraffin tissue blocks and slides from all lymph nodes removed by lymphadenectomy were re-analyzed per standard ultrastaging protocol aimed at the detection of micrometastases (>0.2 mm and ≤2 mm) and isolated tumor cells (clusters up to 0.2 mm or <200 cells). RESULTS The study included 20 patients with median age of 42 (range 30-68) years. Most patients were randomized to minimally invasive surgery (90%), had squamous cell carcinoma (65%), FIGO 2009 stage 1B1 (95%), grade 2 (60%) disease, had no adjuvant treatment (75%), and had a single site of recurrence (55%), most commonly at the vaginal cuff (45%). Only one patient had pelvic sidewall recurrence in the absence of other disease sites. The median number of lymph nodes analyzed per patient was 18.5 (range 4-32) for a total of 412 lymph nodes. A total of 621 series and 1242 slides were reviewed centrally by the ultrastaging protocol. No metastatic disease of any size was found in any lymph node. CONCLUSIONS There were no lymph node low-volume metastases among patients with initially negative lymph nodes who recurred in the LACC trial. Therefore, it is unlikely that manipulation of lymph nodes containing clinically undetected metastases is the underlying cause of the higher local recurrence risk in the minimally invasive arm of the LACC trial.
Collapse
Affiliation(s)
- Roni Nitecki
- Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pedro T Ramirez
- Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas, USA
| | - Pavel Dundr
- Pathology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Kristyna Nemejcova
- Pathology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Reitan Ribeiro
- Surgery, Hospital Erasto Gaertner, Curitiba, Hospital, Brazil
| | | | | | - Lucio Bedoya
- Gynecologic Oncology, Hospital Misercordia, Cordoba, Argentina
| | - David Ortiz Isla
- Gynecologic Oncology, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Rene Pareja
- Gynecologic Oncology, Clinica Astorga, Medellin, and Instituto Nacional de Cancerología, Bogotá, Medellin, Colombia
| | | | - Aldo Lopez
- Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - David Kushner
- Gynecologic Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - David Cibula
- Obstetrics and Gynecology, University of Prague, Prague, Czech Republic
| |
Collapse
|
5
|
Pache B, Tantari M, Guani B, Mathevet P, Magaud L, Lecuru F, Balaya V. Predictors of Non-Sentinel Lymph Node Metastasis in Patients with Positive Sentinel Lymph Node in Early-Stage Cervical Cancer: A SENTICOL GROUP Study. Cancers (Basel) 2023; 15:4737. [PMID: 37835431 PMCID: PMC10571801 DOI: 10.3390/cancers15194737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The goal of this study was to identify the risk factors for metastasis in the remaining non-sentinel lymph nodes (SLN) in the case of positive SLN in early-stage cervical cancer. METHODS An ancillary analysis of two prospective multicentric databases on SLN biopsy for cervical cancer (SENTICOL I and II) was performed. Patients with early-stage cervical cancer (FIGO 2018 IA to IIA1), with bilateral SLN detection and at least one positive SLN after ultrastaging, were included. RESULTS 405 patients were included in SENTICOL I and Il. Fifty-two patients had bilateral SLN detection and were found to have SLN metastasis. After pelvic lymphadenectomy, metastatic involvement of non-SLN was diagnosed in 7 patients (13.5%). Patients with metastatic non-SLN were older (51.9 vs. 40.8 years, p = 0.01), had more often lympho-vascular space invasion (LVSI) (85.7% vs. 35.6%, p = 0.03), and had more often parametrial involvement (42.9% vs. 6.7%, p = 0.003). Multivariate analysis retained age (OR = 1.16, 95% IC = [1.01-1.32], p = 0.03) and LVSI (OR = 25.97, 95% IC = [1.16-582.1], p = 0.04) as independently associated with non-SLN involvement. CONCLUSIONS Age and LVSI seemed to be predictive of non-SLN metastasis in patients with SLN metastasis in early-stage cervical cancer. Larger cohorts are needed to confirm the results and clinical usefulness of such findings.
Collapse
Affiliation(s)
- Basile Pache
- Department Women-Mother-Child, Gynecology and Obstetrics Unit, Lausanne University Hospital (CHUV), 1005 Lausanne, Switzerland
- University of Lausanne (UNIL), 1015 Lausanne, Switzerland
- Gynecology Department, Fribourg University Hospital, University of Fribourg, 1700 Fribourg, Switzerland
| | - Matteo Tantari
- Unit of Obstetrics and Gynecology, Ospedale Villa Scassi-ASL3, Metropolitan Area of Genoa, 16149 Genoa, Italy
| | - Benedetta Guani
- University of Lausanne (UNIL), 1015 Lausanne, Switzerland
- Gynecology Department, Fribourg University Hospital, University of Fribourg, 1700 Fribourg, Switzerland
| | - Patrice Mathevet
- Department Women-Mother-Child, Gynecology and Obstetrics Unit, Lausanne University Hospital (CHUV), 1005 Lausanne, Switzerland
- University of Lausanne (UNIL), 1015 Lausanne, Switzerland
| | - Laurent Magaud
- Clinical Research and Epidemiology Department, Public Health Center, Hospices Civils de Lyon, F-69003 Lyon, France
| | - Fabrice Lecuru
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, Paris University, F-75005 Paris, France
| | - Vincent Balaya
- Department of Obstetrics and Gynecology, Felix Guyon Hospital, University Hospital La Réunion, F-97490 Saint-Denis, France
- University of La Réunion, F-97744 Saint-Denis, France
| |
Collapse
|
6
|
Naik R, Wood N, Anagnostopoulos A, Yiannakis D. Therapies in Cervical Cancer-Editorial. Cancers (Basel) 2023; 15:cancers15020537. [PMID: 36672486 PMCID: PMC9856916 DOI: 10.3390/cancers15020537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
George Papanikolaou is famously quoted as saying "the first observation of cancer cells in the smear of the uterine cervix gave me one of the greatest thrills I ever experienced during my scientific career" [...].
Collapse
Affiliation(s)
- Raj Naik
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK
- Correspondence:
| | - Nick Wood
- Department of Gynaecological Oncology, Lancashire Teaching Hospital, Preston PR2 9HT, UK
| | | | - Dennis Yiannakis
- Department of Medical Oncology, Lancashire Teaching Hospital, Preston PR2 9HT, UK
| |
Collapse
|
7
|
[Carbon nanoparticle tracing of sentinel lymph nodes in diagnosis and treatment of cervical cancer and clinical value of lymph node ultrastaging detection]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2022; 42:1896-1901. [PMID: 36651260 PMCID: PMC9878409 DOI: 10.12122/j.issn.1673-4254.2022.12.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the clinical value of sentinel lymph node (SLN) detection using carbon nanoparticles in the diagnosis and treatment of cervical cancer and the value of lymph node pathological ultrastaging detection. METHODS A total of 79 patients with cervical cancer in IA2, IB1, IB2, IIA1 and IIICp1 stages admitted to the Department of Gynecology and Obstetrics, Nanfang Hospital between June, 2018 and January, 2021 were included in this study. During the operation, the patients were injected with a total of 0.25 mL carbon nanoparticles at 3 and 9 o'clock of the normal cervix after general anesthesia. The first black-dyed lymph nodes were identified as SLNs and removed one by one. All the patients underwent pelvic lymph node dissection and radical hysterectomy with or without para-aortic lymphadenectomy. The black-dyed SLNs were removed for routine pathological examination. Thirty patients with negative SLNs were randomly selected for pathological ultrastaging. RESULTS In 67 of the 79 patients, a total of 417 SLNs were detected with a detection rate of 84.8%; in each patient, at least 1 SLN was detected with a mean SLN number of 5.28. After the operation, 5 patients were found to have positive SLNs; 1 patient was negative for SLN but positive for non-SLN. The sensitivity of SLN biopsy was 83.3% with a specificity of 100%, false negative rate of 16.7%, an accuracy of 98.5% and a negative predictive value of 98.4%. SLN was distributed mainly in the obturator region, the external iliac region, the internal iliac region and the total iliac region (15.11%). Univariate and multivariate analyses suggested that preoperative cervical coning (P=0.045 and 0.009) and tumor size (P=0.033 and 0.008) significantly affected the overall detection rate of SLN. Kappa test showed a high consistency between SLN and pelvic lymph node metastasis status (Kappa value=0.901, P < 0.001). In 30 patients with negative pathological results of SLN, pathological ultrastaging detection identified no micrometastases or isolated tumor cells. CONCLUSION Carbon nanoparticle tracing of the SLNs is safe and feasible in the diagnosis and treatment of cervical cancer, and SLN detection is safe in patients with primary lesion size below 2 cm or without cervical conization. SLN combined with pathological ultrastaging detection does not improve the detection rate of isolated tumor cells or micrometastases.
Collapse
|
8
|
Neoadjuvant Chemotherapy Prior Fertility-Sparing Surgery in Women with FIGO 2018 Stage IB2 Cervical Cancer: A Systematic Review. Cancers (Basel) 2022; 14:cancers14030797. [PMID: 35159063 PMCID: PMC8833789 DOI: 10.3390/cancers14030797] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary In order to provide our contribution to the knowledge of women affected by IB2 cervical cancer, who wish to preserve fertility, we revised and updated the available literature in the debated issue of neoadjuvant chemotherapy prior to fertility-sparing treatment. The effectiveness of preoperative chemotherapy in tumors larger than 2 cm virtually proposes a conservative opportunity to a broader group of women, while keeping low, and hopefully absent, the risk of local and distant relapse. Available studies of neoadjuvant chemotherapy to the fertility-sparing approach have shown that a suboptimal response at surgery seems to be an independent prognostic factor in poorer survival, and, therefore, the careful selection of patients and the surgical approach after neoadjuvant chemotherapy remains crucial. Finally, we proposed an algorithm to be helpful in the decision-making process of that subgroup of patients. Abstract Nowadays, the optimal management of patients with cervical cancers measuring 2–4 cm desiring to maintain fertility is still uncertain. In this systematic review, we assessed the reliability of neoadjuvant chemotherapy (NACT) prior to fertility-sparing (FS) surgery in International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IB2 cervical cancer, in terms of pathologic response, oncological and obstetric outcomes. The review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data, using MEDLINE and PubMed, were searched for from 1 January 2005 up to 1 December 2020. We identified 20 articles and 114 women with IB2 disease, possible candidates for NACT prior to FS surgery. However, uterine conservation was achieved only in 76.7% of them. Patients reached optimal pathological response to NACT in 60.9% of cases and a TIP (cisplatin, ifosfamide and paclitaxel) regime was related to the best response. Suboptimal response to NACT appeared to be an independent negative prognostic factor. Up to 9.2% of patients recurred with a median 7.4-months DFS, and 4.6% of patients died of disease. Fifty percent of women tried to conceive after treatment and NACT prior to conization appeared to be the most promising alternative to upfront radical trachelectomy in terms of obstetric outcomes. In conclusion, NACT prior to FS surgery is an option, but the literature about this issue is still weak and FS should be carefully discussed with patients.
Collapse
|
9
|
Value of routine cytokeratin immunohistochemistry in detecting low volume disease in cervical cancer. Gynecol Oncol 2022; 165:257-263. [DOI: 10.1016/j.ygyno.2022.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 12/20/2022]
|
10
|
Fernandez-Gonzalez S, Ponce J, Martínez-Maestre MÁ, Barahona M, Gómez-Hidalgo NR, Díaz-Feijoo B, Casajuana A, Gracia M, Frias-Gomez J, Benavente Y, Costas L, Martí L, Melero L, Silvan JM, Beiro E, Lobo I, De la Rosa J, Coronado PJ, Gil-Moreno A. The Impact of Surgical Practice on Oncological Outcomes in Robot-Assisted Radical Hysterectomy for Early-Stage Cervical Cancer, Spanish National Registry. Cancers (Basel) 2022; 14:cancers14030698. [PMID: 35158966 PMCID: PMC8833333 DOI: 10.3390/cancers14030698] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/20/2022] [Accepted: 01/28/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Minimal invasive surgery (MIS) has been associated with lower disease-free survival than open surgery among women who underwent radical hysterectomy for early-stage cervical cancer. However, the mechanisms by which MIS increases mortality in cervical cancer remain uncertain. We aimed to determine if surgical practice among centers using robotic surgery has an impact on oncological outcomes. We evaluated 215 women with early-stage cervical cancer (≤IB1 or IIA1, FIGO 2009) who underwent robot-assisted radical hysterectomy in five Spanish tertiary centers between 2009 and 2018. A higher surgical volume, higher participation in clinical trials, higher rate of MRI use for diagnosis, greater use of sentinel lymph node biopsies, and a favorable learning curve with low rates of early recurrences were observed for the centers with better oncological outcomes. These factors might have a significant impact on oncological outcomes in all surgical approaches. Abstract This study aimed to assess whether surgical practice had a significant impact on oncological outcomes among women who underwent robot-assisted radical hysterectomy for early-stage cervical cancer (≤IB1 or IIA1, FIGO 2009). The secondary objective was to audit the pre-surgical quality indicators (QI) proposed by the European Society of Gynaecological Oncology (ESGO). The top 5 of 10 centers in Spain and Portugal were included in the analysis. The hospitals were divided into group A (n = 118) and group B (n = 97), with recurrence rates of <10% and >10%, respectively. After balancing both groups using the propensity score, the ORs for all events were higher and statistically significant for group B (recurrences OR = 1.23, 95% CI = 1.13–1.15, p-value = 0.001; death OR = 1.10, 95% CI = 1.02–1.18, p-value = 0.012; disease-specific mortality ORr = 1.11, 95% CI = 1.04–1.19, p-value = 0.002). A higher surgical volume, higher participation in clinical trials, higher rate of MRI use for diagnosis, greater use of sentinel lymph node biopsies, and a favorable learning curve with low rates of early recurrences were observed among the centers with better oncological outcomes. These factors might have a significant impact on oncological outcomes not only after robot-assisted surgery, but also after laparoscopies and open surgeries in the treatment of cervical cancer.
Collapse
Affiliation(s)
- Sergi Fernandez-Gonzalez
- Department of Gynecology, Bellvitge University Hospital, IDIBELL, L’Hospitalet de Llobregat, Universitat de Barcelona, 08907 Barcelona, Spain; (M.B.); (L.M.)
- Correspondence: (S.F.-G.); (J.P.)
| | - Jordi Ponce
- Department of Gynecology, Bellvitge University Hospital, IDIBELL, L’Hospitalet de Llobregat, Universitat de Barcelona, 08907 Barcelona, Spain; (M.B.); (L.M.)
- Correspondence: (S.F.-G.); (J.P.)
| | | | - Marc Barahona
- Department of Gynecology, Bellvitge University Hospital, IDIBELL, L’Hospitalet de Llobregat, Universitat de Barcelona, 08907 Barcelona, Spain; (M.B.); (L.M.)
| | - Natalia R. Gómez-Hidalgo
- Department of Gynecologic Oncology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (N.R.G.-H.); (A.G.-M.)
| | - Berta Díaz-Feijoo
- Institute Clinic of Gynecology, Obstetrics and Neonatotlogy, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Andrea Casajuana
- Instituto de Salud de la Mujer (IdISSC), Hospital Clínico San Carlos, Universidad Complutense Madrid, 28040 Madrid, Spain; (A.C.); (M.G.); (P.J.C.)
| | - Myriam Gracia
- Instituto de Salud de la Mujer (IdISSC), Hospital Clínico San Carlos, Universidad Complutense Madrid, 28040 Madrid, Spain; (A.C.); (M.G.); (P.J.C.)
| | - Jon Frias-Gomez
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (J.F.-G.); (Y.B.); (L.C.)
| | - Yolanda Benavente
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (J.F.-G.); (Y.B.); (L.C.)
| | - Laura Costas
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (J.F.-G.); (Y.B.); (L.C.)
| | - Lola Martí
- Department of Gynecology, Bellvitge University Hospital, IDIBELL, L’Hospitalet de Llobregat, Universitat de Barcelona, 08907 Barcelona, Spain; (M.B.); (L.M.)
| | - Lidia Melero
- Department of Gynecology, Hospital Universitario Virgen del Rocio, 41001 Sevilla, Spain; (M.Á.M.-M.); (L.M.); (J.M.S.)
| | - Jose Manuel Silvan
- Department of Gynecology, Hospital Universitario Virgen del Rocio, 41001 Sevilla, Spain; (M.Á.M.-M.); (L.M.); (J.M.S.)
| | - Eva Beiro
- Department of Gynecology, Hospital Universitario de Basurto, 48013 Bilbao, Spain; (E.B.); (I.L.); (J.D.l.R.)
| | - Ignacio Lobo
- Department of Gynecology, Hospital Universitario de Basurto, 48013 Bilbao, Spain; (E.B.); (I.L.); (J.D.l.R.)
| | - Jesús De la Rosa
- Department of Gynecology, Hospital Universitario de Basurto, 48013 Bilbao, Spain; (E.B.); (I.L.); (J.D.l.R.)
| | - Pluvio J. Coronado
- Instituto de Salud de la Mujer (IdISSC), Hospital Clínico San Carlos, Universidad Complutense Madrid, 28040 Madrid, Spain; (A.C.); (M.G.); (P.J.C.)
| | - Antonio Gil-Moreno
- Department of Gynecologic Oncology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (N.R.G.-H.); (A.G.-M.)
| |
Collapse
|
11
|
Tantari M, Bogliolo S, Morotti M, Balaya V, Bouttitie F, Buenerd A, Magaud L, Lecuru F, Guani B, Mathevet P. Lymph Node Involvement in Early-Stage Cervical Cancer: Is Lymphangiogenesis a Risk Factor? Results from the MICROCOL Study. Cancers (Basel) 2022; 14:cancers14010212. [PMID: 35008376 PMCID: PMC8750515 DOI: 10.3390/cancers14010212] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/27/2021] [Accepted: 12/31/2021] [Indexed: 02/04/2023] Open
Abstract
Simple Summary The prognosis of cervical cancer is significantly influenced by lymph node involvement. The lymphatic system is the primary way of metastasis for cervical carcinoma, and lymph-vascular space invasion (LVSI) is considered the most important risk factor for pelvic lymph node metastasis (PLNM). Previous studies have not clarified the correlation between lymphangiogenesis and an increased risk of metastasis and tumor recurrence. The evaluation and identification of several markers of lymphangiogenesis may identify patients with high risk of PLNM. Our findings suggest that the lymphatic spread does not required the proliferation of new lymphatic endothelial cells. These results emphasize the importance of pre-existing peritumoral lymphatic vessels in the metastatic process in early cervical cancer. Abstract 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.
Collapse
Affiliation(s)
- Matteo Tantari
- Gynecology Department, Centre Hopital-Universitaire Vaudois, 1011 Lausanne, Switzerland; (M.M.); (V.B.); (B.G.); (P.M.)
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Università degli Studi di Genova, 16128 Genoa, Italy
- Correspondence:
| | - Stefano Bogliolo
- Department of Obstetrics and Gynecological Oncology, “P.O del Tigullio” Hospital-ASL4, Metropolitan Area of Genoa, 16128 Genoa, Italy;
| | - Matteo Morotti
- Gynecology Department, Centre Hopital-Universitaire Vaudois, 1011 Lausanne, Switzerland; (M.M.); (V.B.); (B.G.); (P.M.)
| | - Vincent Balaya
- Gynecology Department, Centre Hopital-Universitaire Vaudois, 1011 Lausanne, Switzerland; (M.M.); (V.B.); (B.G.); (P.M.)
- Department of Gynecology and Obstetrics, Foch Hospital, 92150 Suresnes, France
| | - Florent Bouttitie
- Department of Biostatistics, University Hospital of Lyon, 69002 Lyon, France;
| | - Annie Buenerd
- Department of Pathology, Hospices Civils de Lyon HCL, 69000 Lyon, France;
| | - Laurent Magaud
- Clinical Research and Epidemiology Department, Hospices Civils de Lyon, 69000 Lyon, France;
- Faculty of Medicine, University of Lyon, Claude Bernard Lyon 1, 69007 Lyon, France
| | - Fabrice Lecuru
- Faculty of Medicine, University of Paris, 75006 Paris, France;
- Breast, Gynecology and Reconstructive Surgery Unit, Curie Institute, 75005 Paris, France
| | - Benedetta Guani
- Gynecology Department, Centre Hopital-Universitaire Vaudois, 1011 Lausanne, Switzerland; (M.M.); (V.B.); (B.G.); (P.M.)
- Department of Gynecology, HFR, 1708 Fribourg, Switzerland
- Faculty of Medicine, University of Fribourg, 1700 Fribourg, Switzerland
| | - Patrice Mathevet
- Gynecology Department, Centre Hopital-Universitaire Vaudois, 1011 Lausanne, Switzerland; (M.M.); (V.B.); (B.G.); (P.M.)
- Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland
| | | |
Collapse
|
12
|
Guani B, Mahiou K, Crestani A, Cibula D, Buda A, Gaillard T, Mathevet P, Kocian R, Sniadecki M, Wydra DG, Feki A, Paoletti X, Lecuru F, Balaya V. Clinical impact of low-volume lymph node metastases in early-stage cervical cancer: A comprehensive meta-analysis. Gynecol Oncol 2021; 164:446-454. [PMID: 34949436 DOI: 10.1016/j.ygyno.2021.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/01/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE In order to define the clinical significance of low-volume metastasis, a comprehensive meta-analysis of published data and individual data obtained from articles mentioning micrometastases (MIC) and isolated tumor cells (ITC) in cervical cancer was performed, with a follow up of at least 3 years. METHODS We performed a systematic literature review and meta-analysis, following Cochrane's review methods guide and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome was the disease-free survival (DFS), and the secondary outcome was the overall survival (OS). The hazard ratio (HR) was taken as the measure of the association between the low-volume metastases (MIC+ITC and MIC alone) and DFS or OS; it quantified the hazard of an event in the MIC (+/- ITC) group compared to the hazard in node-negative (N0) patients. A random-effect meta-analysis model using the inverse variance method was selected for pooling. Forest plots were used to display the HRs and risk differences within individual trials and overall. RESULTS Eleven articles were finally retained for the meta-analysis. In the analysis of DFS in patients with low-volume metastasis (MIC + ITC), the HR was increased to 2.60 (1.55-4.34) in the case of low-volume metastasis vs. N0. The presence of MICs had a negative prognostic impact, with an HR of 4.10 (2.71-6.20) compared to N0. Moreover, this impact was worse than that of MIC pooled with ITCs. Concerning OS, the meta-analysis shows an HR of 5.65 (2.81-11.39) in the case of low-volume metastases vs. N0. The presence of MICs alone had a negative effect, with an HR of 6.94 (2.56-18.81). CONCLUSIONS In conclusion, the presence of MIC seems to be associated with a negative impact on both the DFS and OS and should be treated as MAC.
Collapse
Affiliation(s)
- Benedetta Guani
- Department of Gynecology and Obstetrics, CHUV Lausanne, Lausanne, Switzerland; Faculty of Medicine and Biology, UNIL Lausanne, Lausanne, Switzerland; Department of Gynecology and Obstetrics, HFR Fribourg, Fribourg, Switzerland; Faculty of Medicine, University of Fribourg, 1700 Fribourg, Switzerland.
| | - Katia Mahiou
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, Paris, France
| | - Adrien Crestani
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, Paris, France
| | - David Cibula
- Department of Obstetrics and Gynecology of the 1(st) Faculty of Medicine, General University Hospital in Prague, Czech Republic
| | - Alessandro Buda
- Department of Gynecology Oncology, Michele e Pietro Ferrero Hospital, Verduno, Italy
| | - Thomas Gaillard
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, Paris, France
| | - Patrice Mathevet
- Department of Gynecology and Obstetrics, CHUV Lausanne, Lausanne, Switzerland; Faculty of Medicine and Biology, UNIL Lausanne, Lausanne, Switzerland
| | - Roman Kocian
- Department of Obstetrics and Gynecology of the 1(st) Faculty of Medicine, General University Hospital in Prague, Czech Republic
| | - Marcin Sniadecki
- Department of Gynecology, Gynecologic Oncology and Gynecologic Endocrinology, Medical University of Gdansk, Poland
| | - Dariusz G Wydra
- Department of Gynecology, Gynecologic Oncology and Gynecologic Endocrinology, Medical University of Gdansk, Poland
| | - Anis Feki
- Department of Gynecology and Obstetrics, HFR Fribourg, Fribourg, Switzerland; Faculty of Medicine, University of Fribourg, 1700 Fribourg, Switzerland
| | - Xavier Paoletti
- Faculty of Medicine, University of Paris, 75006 Paris, France; Department of Biostatistics, Institut Curie, Paris, France
| | - Fabrice Lecuru
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, Paris, France; Faculty of Medicine, University of Paris, 75006 Paris, France
| | - Vincent Balaya
- Department of Gynecology and Obstetrics, CHUV Lausanne, Lausanne, Switzerland; Department of Gynecology and Obstetrics, FOCH Hospital, 92150 Suresnes, France
| |
Collapse
|
13
|
Zhao H, Wang L, Wang S, Chen X, Liang M, Zhang X, Wang J, Xu X. CHN1 promotes epithelial-mesenchymal transition via the Akt/GSK-3β/Snail pathway in cervical carcinoma. J Transl Med 2021; 19:295. [PMID: 34238315 PMCID: PMC8264971 DOI: 10.1186/s12967-021-02963-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/25/2021] [Indexed: 12/02/2022] Open
Abstract
Background Metastasis and invasion are crucial in determining the mortality of cervical carcinoma (CC) patients. The epithelial–mesenchymal transition (EMT) is now a universal explanation for the mechanisms of tumor metastasis. Α-chimeric protein (α-chimaerin, CHN1) plays an important role in the regulation of signal transduction and development. However, the molecular regulatory relationships between CHN1 and CC progression in relation to EMT have not yet been identified. Methods The expression of CHN1 in CC tissues, adjacent tissues, and lymph node metastases from CC patients was detected by immunohistochemistry. Upregulation and knockdown of CHN1 were achieved by transfection of CC cells. The effect of CHN1 on cell proliferation was determined by CCK-8 and plate clone formation assays. Changes in migration and invasion capabilities were evaluated using scratch migration and transwell invasion assays. The effect of CHN1 overexpression and interference on xenograft tumor growth was determined by tumor weight and pathological analyses. The expression of EMT-related mRNAs was measured by qRT-PCR in transfected CC cells. EMT-related proteins and Akt/GSK-3β/Snail signaling pathway-related proteins were also evaluated by western blotting. Results CHN1 was overexpressed in CC tissues and was associated with lymph node metastasis and low survival in CC patients. Overexpression of CHN1 promoted cell proliferation, migration, and invasion in CC cells. In contrast, silencing of CHN1 inhibited these phenomena. Overexpression of CHN1 promoted tumor formation in an in vivo xenograft tumor mouse model, with increased tumor volumes and weights. In addition, CHN1 induced the expression of EMT-related transcription factors, accompanied by the decreased expression of epithelial markers and increased expression of mesenchymal markers. The Akt/GSK-3β/Snail signaling pathway was activated by overexpression of CHN1 in vitro, and activation of this pathway was inhibited by the signaling pathway inhibitor LY294002. Conclusion These results suggest that CHN1 promotes the development and progression of cervical carcinoma via the Akt/GSK-3β/Snail pathway by inducing EMT. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-021-02963-7.
Collapse
Affiliation(s)
- Haoqi Zhao
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.,Reproductive Physiology Laboratory, National Research Institute for Family Planning, Beijing, 100081, China.,National Engineering and Research Center of Continuous Casting Technology, China Iron and Steel Research Institute Group, Beijing, 100081, China
| | - Lan Wang
- Biopharmaceutical R&D Center, Chinese Academy of Medical Sciences & Peking Union Medical College, Suzhou, 215126, Jiangsu, China
| | - Shufang Wang
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.,Reproductive Physiology Laboratory, National Research Institute for Family Planning, Beijing, 100081, China.,Department of Forensic Medicine, Xinxiang Medical University, Xinxiang, 453003, Henan, China
| | - Xihua Chen
- Reproductive Physiology Laboratory, National Research Institute for Family Planning, Beijing, 100081, China
| | - Min Liang
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.,Reproductive Physiology Laboratory, National Research Institute for Family Planning, Beijing, 100081, China
| | - Xin Zhang
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.,Reproductive Physiology Laboratory, National Research Institute for Family Planning, Beijing, 100081, China
| | - Jiedong Wang
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.,Reproductive Physiology Laboratory, National Research Institute for Family Planning, Beijing, 100081, China
| | - Xiangbo Xu
- Reproductive Physiology Laboratory, National Research Institute for Family Planning, Beijing, 100081, China.
| |
Collapse
|
14
|
Bizzarri N, Luigi PA, Ferrandina G, Zannoni GF, Carbone MV, Fedele C, Teodorico E, Gallotta V, Gueli Alletti S, Chiantera V, Fagotti A, Scambia G, Fanfani F. Sentinel lymph node mapping with indocyanine green in cervical cancer patients undergoing open radical hysterectomy: a single-institution series. J Cancer Res Clin Oncol 2021; 147:649-659. [PMID: 33000339 PMCID: PMC7873085 DOI: 10.1007/s00432-020-03393-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/10/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the rate of bilateral sentinel lymph node (SLN) detection with indocyanine green (ICG), to evaluate the sensitivity and the negative predictive value of cervical cancer patients undergoing open radical hysterectomy; to compare open versus minimally invasive SLN biopsy performance and to assess factors related to no/unilateral SLN mapping. METHODS We retrospectively reviewed consecutive patients with FIGO 2018 stage IA1 with lymph-vascular space involvement to IIB and IIIC1p cervical carcinoma who underwent SLN mapping with ICG followed by systematic pelvic lymphadenectomy between 05/2017 and 06/2020. Patients were divided according to surgical approach for statistical analysis. RESULTS Eighty-five patients met inclusion criteria. Twenty-seven (31.8%) underwent open and 58 (68.2%) underwent minimally invasive SLN mapping. No difference in any SLN mapping (laparotomy 92.6% and minimally invasive 91.4%) or in SLN bilateral detection (laparotomy 72.0% and minimally invasive 84.9%) (p = 0.850 and p = 0.222, respectively), in median number of SLNs mapped and retrieved (2 in both groups, p = 0.165) and in site of SLN mapping per hemi-pelvis (right side, p = 0273 and left side, p = 0.618) was evident between open and minimally invasive approach. Per-patient sensitivity of SLN biopsy in laparotomy was 83.3% (95% CI 35.9-99.6%) and the negative predictive value was 95.0% (95% CI 76.0-99.1%). No difference in per-patient sensitivity was noted between two approaches (p = 0.300). None of the analyzed variables was associated with no/unilateral SLN mapping. CONCLUSION The use of ICG to detect SLN in cervical cancer treated with open surgery allows a bilateral detection, sensitivity and negative predictive value comparable to minimally invasive surgery with potential advantages of ICG compared to other tracers.
Collapse
Affiliation(s)
- Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Pedone Anchora Luigi
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Gabriella Ferrandina
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Gian Franco Zannoni
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
- Unità di Gineco-Patologia e Patologia Mammaria, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Maria Vittoria Carbone
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Camilla Fedele
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Elena Teodorico
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Valerio Gallotta
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Salvatore Gueli Alletti
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, ARNAS Ospedali Civico di Cristina Benfratelli, University of Palermo, Piazza Nicola Leotta 4/A, 90127, Palermo, Italy
| | - Anna Fagotti
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy.
| | - Francesco Fanfani
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| |
Collapse
|
15
|
Gu HF, Liu GC, Chen JP, Li JY, Zhang XK, Liu ZM, Tu H. Proposal for modified inguinofemoral lymphadenectomy derived from investigation of anatomic distribution of sentinel and metastatic nodes in vulvar cancer. J Surg Oncol 2020; 123:660-666. [PMID: 33155291 DOI: 10.1002/jso.26290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/09/2020] [Accepted: 10/23/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We aimed to develop a less invasive inguinofemoral lymphadenectomy (IFL) approach for vulvar cancer based on the investigation of the anatomic distribution of sentinel and metastatic nodes. METHODS Patients with vulvar cancer treated by surgery between 1995 and 2019 were retrospectively reviewed. A seven-field method was adopted to assign the anatomic locations for lymph nodes removed via IFL or sentinel node biopsy. Only patients with nodal metastasis or sentinel nodes were included. RESULTS A total of 102 patients with eligible data were analyzed. Nodal metastasis was confirmed in 118 groins undergoing IFL; sentinel node detection succeeded in 46 groins. The medial-inguinal field had the highest rate of nodal metastasis involvement (59.3%, 70/118) and sentinel nodes present (73.9%, 34/46). The inferior-femoral field was involved only in one groin with quadruple-field metastases. The lateral-inguinal field was not involved in any groin. Neither the lateral-inguinal nor the inferior-femoral field presented sentinel nodes. CONCLUSION The lateral-inguinal and inferior-femoral fields of the groins have a low risk of developing nodal metastasis. Therefore, a modified IFL preserving these fields can be established to reduce surgical morbidity without sacrificing its therapeutic effect.
Collapse
Affiliation(s)
- Hai-Feng Gu
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Guo-Chen Liu
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jie-Ping Chen
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jun-Yun Li
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xin-Ke Zhang
- Department of Pathology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhi-Min Liu
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Hua Tu
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| |
Collapse
|
16
|
Santoro A, Angelico G, Inzani F, Arciuolo D, Spadola S, Valente M, D'Alessandris N, Piermattei A, Fiorentino V, CIanfrini F, Bizzarri N, Pedone Anchora L, Fagotti A, Scambia G, Zannoni GF. Standard ultrastaging compared to one-step nucleic acid amplification (OSNA) for the detection of sentinel lymph node metastases in early stage cervical cancer. Int J Gynecol Cancer 2020; 30:1871-1877. [PMID: 33127865 DOI: 10.1136/ijgc-2020-001710] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE We compared ultrastaging and one-step nucleic acid amplification (OSNA) examination of sentinel lymph nodes in two homogeneous patient populations diagnosed with early stage cervical cancer. The primary aim of our study was to evaluate the rate and type of sentinel lymph node metastases detected by ultrastaging and OSNA assay. Secondary aims were to define the sensitivity and the negative predictive value of sentinel lymph node biopsy assessed with OSNA and ultrastaging and to define the role of sentinel lymph node assessment in predicting non-sentinel lymph node status. METHODS Consecutive patients who underwent surgery (radical hysterectomy or trachelectomy or cervical conization) at our institution, between January 2018 and March 2020, were enrolled. All patients had a preoperative diagnosis of early-stage cervical carcinoma (International Federation of Gynecology and Obstetrics (FIGO) 2018 stages IA-IIB) and underwent sentinel lymph node assessment with ultrastaging or OSNA. Patients with advanced FIGO stages and special histology subtypes (other than squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma) or patients with sentinel lymph nodes analyzed only with hematoxylin and eosin were excluded. Clinical data were compared using the χ2 test and Fisher's exact test. A κ coefficient was determined with respect to lymph node assessment. A p value <0.05 was considered statistically significant. RESULTS A total of 116 patients were included in this retrospective analysis (53 ultrastaging, 63 OSNA). Overall, 531 and 605 lymph nodes were removed in the ultrastaging and OSNA groups, respectively, and 140 and 129 sentinel lymph nodes were analyzed in the ultrastaging and OSNA groups, respectively. 22 patients had metastatic sentinel lymph nodes: 6 (11.3%) of 53 patients in the ultrastaging group and 16 (25.4%) of 63 patients in the OSNA group. The total amount of positive SLNs was 7 (5%) of 140 in the ultrastaging group and 21 (16.3%) of 129 in the OSNA group, respectively (p=0.0047). Pelvic lymphadenectomy was performed in 26 (49.1%) of 53 patients in the ultrastaging group and in 34 (54%) of 63 patients in the OSNA group due to comorbidities. Metastatic non-sentinel lymph nodes were found in 4 patients: 2 (7.7%) of 26 patients in the ultrastaging group and 2 (5.9%) of 34 patients in the OSNA group, respectively. The total amount of positive pelvic lymph nodes was 3 (0.6%) of 531 in the ultrastaging group and 4 (0.7%) of 605 in the OSNA group (p=0.61). In the OSNA group, only 2 patients with negative sentinel lymph nodes had metastatic disease in the pelvic lymph nodes. By contrast, no patients with OSNA-positive sentinel lymph nodes had metastases in the pelvic lymph nodes. In the ultrastaging group, all patients with negative sentinel lymph nodes did not have metastatic disease in other pelvic lymph nodes. CONCLUSIONS OSNA assessment of sentinel lymph nodes was associated with a negative predictive value of 91% but poor reliability in detecting node metastases in non-sentinel pelvic lymph nodes. Of note, the ultrastaging protocol revealed higher sensitivity and more reliability in predicting pelvic non-sentinel lymph node status.
Collapse
Affiliation(s)
- Angela Santoro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecopatologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Angelico
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecopatologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Frediano Inzani
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecopatologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Damiano Arciuolo
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecopatologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Saveria Spadola
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecopatologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Michele Valente
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecopatologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicoletta D'Alessandris
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecopatologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessia Piermattei
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecopatologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vincenzo Fiorentino
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecopatologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Federica CIanfrini
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecopatologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicolò Bizzarri
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luigi Pedone Anchora
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anna Fagotti
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gian Franco Zannoni
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecopatologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy .,Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|