title: Prognostic significance of low volume sentinel lymph node disease in early-stage cervical cancer.
abstract: OBJECTIVE
  Evaluate prognostic significance of low volume disease detected in sentinel nodes (SN) of patients with early stages cervical cancer. Although pathologic ultrastaging of SN allows for identification of low volume disease, including micro-metastasis and isolated tumor cells (ITC), in up to 15% of cases, prognostic significance of these findings is unknown.
  
  
  METHODS
  A total of 645 records from 8 centers were retrospectively reviewed. Enrolled in our study were patients with early-stage cervical cancer who had undergone surgical treatment including SN biopsy followed by pelvic lymphadenectomy and pathologic ultrastaging of SN.
  
  
  RESULTS
  Macrometastasis, micrometastasis, and ITC were detected by SN ultrastaging in 14.7%, 10.1%, and 4.5% patients respectively. False negativity of SN ultrastaging reached 2.8%. The presence of ITC was not associated with significant risk, both for recurrence free survival and overall survival. Overall survival was significantly reduced in patients with macrometastasis and micrometastasis; hazard ratio for overall survival reached 6.85 (95% CI, 2.59-18.05) and 6.86 (95% CI, 2.09-22.61) respectively. Presence of micrometastasis was an independent prognostic factor for overall survival in a multivariable model.
  
  
  CONCLUSIONS
  Presence of micrometastasis in SN in patients with early stage cervical cancer was associated with significant reduction of overall survival, which was equivalent to patients with macrometastasis. No prognostic significance was found for ITC. These data highlight the importance of SN biopsy and pathologic ultrastaging for the management of cervical cancer.
authors: Gynecological Oncology Centre, Department of Obstetrics and Gynecology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic. david.cibula@iol.cz
authors: D
authors: D
authors: Cibula
authors: N R
authors: NR
authors: Abu-Rustum
authors: L
authors: L
authors: Dusek
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authors: M
authors: Zikán
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authors: Zaal
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authors: Sevcik
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authors: GG
authors: Kenter
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authors: Querleu
authors: R
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authors: Jach
authors: A S
authors: AS
authors: Bats
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authors: Dyduch
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authors: Graf
authors: J
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authors: Klat
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authors: Lacheta
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authors: CJ
authors: Meijer
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authors: Mery
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authors: Verheijen
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authors: RP
authors: Zweemer
mesh_terms: D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D002583:Uterine Cervical Neoplasms / Q000473:pathology*