title: Evidence of tumor heterogeneity in cervical cancers and lymph node metastases as determined by flow cytometry.
abstract: BACKGROUND
  The incidence and significance of tumor heterogeneity in primary tumors and metastatic lymph nodes were investigated in Stage IB-IIA cervical cancers.
  
  
  METHODS
  Paraffin-embedded tissues from 96 radical hysterectomy specimens were dewaxed, disaggregated, and subjected to dual parameter flow cytometry. Three-dimensional histograms were generated to delineate different tumor populations. A DNA index difference of at least +/- 0.15 was used to define tumor heterogeneity.
  
  
  RESULTS
  Mean DNA index difference of various tumor populations was 0.29 +/- 0.13. Among 69 patients with normal lymph nodes, there were 12 patients (incidence, 17.4%) with tumor heterogeneity in the primary tumors. Of 27 patients with metastatic lymph nodes, 5 (incidence, 18.5%) had evidence of tumor heterogeneity in the primary tumor, and 18 of 47 (incidence, 38.3%) had tumor heterogeneity in metastatic lymph nodes. When using DNA index to determine clonal origin of metastatic lymph nodes, as many as 60% of the metastases could not be traced to the primary tumor. Tumor heterogeneity was associated with a 40% reduction in median survival time. However, because of the small number of patients with tumor heterogeneity, statistical analyses did not show prognostic significance.
  
  
  CONCLUSIONS
  Tumor heterogeneity appeared to be a common characteristic of early cervical carcinoma. Additional study is needed to fully evaluate its prognostic value.
authors.affiliation: Department of Obstetrics and Gynecology, University of Miami School of Medicine, Florida 33101.
authors.forename: H N
authors.initials: HN
authors.lastname: Nguyen
authors.forename: B U
authors.initials: BU
authors.lastname: Sevin
authors.forename: H E
authors.initials: HE
authors.lastname: Averette
authors.forename: R
authors.initials: R
authors.lastname: Ramos
authors.forename: P
authors.initials: P
authors.lastname: Ganjei
authors.forename: J
authors.initials: J
authors.lastname: Perras
mesh_terms: D000230:Adenocarcinoma / Q000235:genetics / Q000401:mortality / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000235:genetics / Q000401:mortality / Q000473:pathology; D004273:DNA, Neoplasm / Q000032:analysis*; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D008207:Lymphatic Metastasis; D011003:Ploidies; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000235:genetics* / Q000401:mortality / Q000473:pathology
chemical_list: D004273:DNA, Neoplasm