Slama Jiri, Drazdakova Marcela, Dundr Pavel, Fischerova Daniela, Zikan Michal, Pinkavova Ivana, Freitag Pavel, Pavlista David, Zima Tomas, Cibula David
General Teaching Hospital, Department of Oncogynecology, 1st Medical School of Charles University, Prague 2, Czech Republic.
Int J Gynecol Cancer. 2009 May;19(4):703-7. doi: 10.1111/IGC.0b013e3181a13186.
Metastatic involvement of pelvic lymph nodes is the most important prognostic parameter in early-stage cervical cancer. Still, approximately 15% of patients with negative pelvic nodes experience recurrence, most of them in the pelvis. The presence of human papillomavirus (HPV) DNA in histologically negative pelvic nodes is considered a subclinical metastatic spread.
Patients with early-stage cervical cancer referred for surgical treatment were enrolled in the study. Cytobrush technique was used for sample collection from the fresh tissue to avoid any loss of material for histology.
Altogether, 49 patients were enrolled in the study. High-risk (HR) HPV DNA was identified in the tumor in 91.8% patients and in the sentinel node or other pelvic nodes in 49.9% patients. Among the 10 HR HPV genotypes detected, HPV 16 was the most frequently represented in both the tumor and the lymph nodes (66.7% and 71.4%, respectively). All metastatic lymph nodes were HR HPV positive.
The presence of HR HPV DNA in a sentinel node had a 100% positive predictive value for metastatic involvement of pelvic lymph nodes in our study. This could be considered a sign of an early subclinical metastatic spread; however, the prognostic value has to be evaluated through a longer follow-up.
盆腔淋巴结转移是早期宫颈癌最重要的预后参数。然而，约15%盆腔淋巴结阴性的患者会复发，其中大多数复发于盆腔。组织学检查阴性的盆腔淋巴结中存在人乳头瘤病毒（HPV）DNA被认为是亚临床转移扩散。
纳入因手术治疗而转诊的早期宫颈癌患者。采用细胞刷技术从新鲜组织中采集样本，以避免组织学检查材料的任何损失。
共纳入49例患者。91.8%的患者肿瘤中检测到高危（HR）HPV DNA，49.9%的患者前哨淋巴结或其他盆腔淋巴结中检测到HR HPV DNA。在检测到的10种HR HPV基因型中，HPV 16在肿瘤和淋巴结中出现的频率最高（分别为66.7%和71.4%）。所有转移淋巴结均为HR HPV阳性。
在我们的研究中，前哨淋巴结中存在HR HPV DNA对盆腔淋巴结转移的阳性预测值为100%。这可被视为早期亚临床转移扩散的标志；然而，其预后价值必须通过更长时间的随访来评估。
