Is systematic scalene node biopsy in pretreatment evaluation of locally advanced cervical carcinoma necessary? Systematic dissection and histopathology of left scalene node biopsies in patients with locally advanced cervical carcinoma.
OBJECTIVE
Cervical carcinomas mainly spread via lymphatics, stepwise from pelvic to aortic and scalenic lymph nodes. Metastatic nodes are the major prognostic factor in this disease. When scalenic nodes are involved, cervical cancer is considered to be disseminated. Since there is a major discrepancy in reported percentages of metastatic scalene nodes in the literature (0 to 50%), we proceeded to systematic pretreatment scalene node biopsy and then evaluated the validity of this procedure.


METHODS
From January 1998 to May 2003, 72 patients with locally advanced cervical carcinoma and no suspicious paraaortic or scalenic nodes (respectively on magnetic resonance imaging and clinically) had a systematic surgical pretreatment lymph node evaluation (retroperitoneal laparoscopic infrarenal paraaortic lymph node dissection and left scalenic lymph node biopsy). Scalene biopsy was examined using hematoxylin/eosin stain and immunohistochemistry (KL1 antibodies).


RESULTS
Among the 72 patients, 20 were stage IB2, 4 were IIA, 14 were IIB, 4 were IIIA, 27 were IIIB, 1 was IVA and 2 had a recurrent cervical carcinoma. Fourteen women had histologically confirmed paraaortic metastases (11 macroscopic, 3 microscopic). No metastatic involvement of the scalene nodes was detected. Fifteen patients developed a recurrence within 12 months (3 to 19 months). None of the patients developed scalenic recurrence.


CONCLUSIONS
Left scalene node biopsy does not appear to be mandatory in routine pretherapeutic lymph node evaluation of patients with advanced cervical carcinoma and no clinical suspicious nodes. It may be useful to prove disseminated disease in patients with suspicious clinical nodes or hot spots on PET-scan, if fine needle biopsy is unconclusive.
Samouëlian
Vanessa
V
Departement of Surgery, Centre Oscar Lambret, 3 rue Frédéric Combemale, BP307, 59020 Lille Cedex, France. v-samouelian@chru-lille.fr
Baranzelli
Marie-Christine
MC
Narducci
Fabrice
F
Taïeb
Solphie
S
Cabaret
Véronique
V
Querleu
Denis
D
Leblanc
Eric
E
D000230:Adenocarcinoma / Q000473:pathology; D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000473:pathology; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008875:Middle Aged; D009333:Neck / Q000473:pathology; D009367:Neoplasm Staging; D015203:Reproducibility of Results; D002583:Uterine Cervical Neoplasms / Q000473:pathology*