title: Rate of para-aortic lymph node micrometastasis in patients with locally advanced cervical cancer.
abstract: OBJECTIVE
  Patients with micrometastasis to para-aortic lymph nodes may benefit from extended field chemoradiation. To determine the rate of para-aortic node micrometastasis in patients with locally advanced cervical cancer undergoing laparoscopic extraperitoneal para-aortic lymphadenectomy.
  
  
  METHODS
  We prospectively identified consecutive patients diagnosed with stage IB2-IVA biopsy-proven cervical cancer. Eligible patients included those who were candidates for treatment with radiotherapy and concurrent chemotherapy and had no evidence of para-aortic lymphadenopathy (all lymph nodes< 2 cm in diameter) by preoperative computed tomography or magnetic resonance imaging. All patients underwent preoperative positron emission tomography/computed tomography and laparoscopic extraperitoneal para-aortic lymphadenectomy. All lymph nodes were assessed for metastasis by routine hematoxylin-eosin (H&E) staining. Ultrastaging (serial sectioning) and immunohistochemical analysis were performed in H&E-negative specimens.
  
  
  RESULTS
  Thirteen (22%) of 60 consecutive patients had para-aortic lymph node metastases detected on routine H&E staining. Of the remaining 47 patients, one (2.1%) had evidence of micrometastasis, which was detected by ultrastaging. This patient completed whole pelvic radiotherapy and chemotherapy but had a recurrence 27 months after completion of therapy.
  
  
  CONCLUSIONS
  The rate of para-aortic node micrometastasis in patients with locally advanced cervical cancer is low. The role of routine ultrastaging and immunohistochemical analysis in such patients remains uncertain. Future studies are needed to determine the clinical impact of para-aortic node micrometastasis in patients with locally advanced cervical cancer.
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA.
authors.forename: Behrouz
authors.initials: B
authors.lastname: Zand
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Euscher
authors.forename: Pamela T
authors.initials: PT
authors.lastname: Soliman
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Schmeler
authors.forename: Robert L
authors.initials: RL
authors.lastname: Coleman
authors.forename: Michael
authors.initials: M
authors.lastname: Frumovitz
authors.forename: Anuja
authors.initials: A
authors.lastname: Jhingran
authors.forename: Lois M
authors.initials: LM
authors.lastname: Ramondetta
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Ramirez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery; D055815:Young Adult