The importance of the histologic processing of pelvic lymph nodes in the treatment of cervical cancer.

Four hundred and twenty surgical specimens from patients undergoing radical abdominal hysterectomy and complete pelvic lymphadenectomy for stage Ib, IIa or IIb cervical cancer underwent meticulous histologic and morphometric study. Complete processing of the extirpated lymphatic fatty tissue led to reproducible findings including the number of removed nodes, the number and size of tumor deposits in the nodes, and the location of the latter in the pelvis. An average of 32 nodes was removed per patient regardless of clinical size, tumor size, or stage. Thirty one per cent of patients with stage Ib disease had positive nodes as did 45% of those with stage IIb disease. The number of node metastases increased proportionally with the size of the primary tumor. In stage Ib 30% of the node metastases were smaller than 2 mm in diameter as were 21% of those in stage IIb. The size of the metastases was directly proportional to the size of the primary tumor. In patients with small tumors 43% of the nodes were smaller than 2 mm, as compared with 15% of those in patients with large tumors. The 5-year survival rate of patients with negative nodes was 89.3%. Survival dropped to 69.8% and 37.9% in patients with 1 or >/= 4 positive nodes, respectively. The 5-year survival rate of patients with node metastases smaller than 2 mm and larger than 20 mm was 70% and 39%, respectively. In patients with identical numbers of positive nodes, survival decreased with increasing tumor size. In patients with tumors of a given size, the number of node metastases was an additional prognostic factor. The number of lymph nodes removed in a given patient is an objective measure of the thoroughness of a lymphadenectomy.