Benedetti-Panici P, Maneschi F, Scambia G, Greggi S, Cutillo G, D'Andrea G, Rabitti C, Coronetta F, Capelli A, Mancuso S
Department of Obstetrics and Gynecology, Catholic University, Rome, Italy.
Gynecol Oncol. 1996 Jul;62(1):19-24. doi: 10.1006/gyno.1996.0184.
To assess the patterns of lymphatic spread in cervical carcinoma, radical hysterectomy with systematic lymphadenectomy was performed in 66 patients FIGO stage IB-IIA <4 cm, and 159 patients stage IB-IIA >4 cm to stage IV. The latter patients were treated with neoadjuvant chemotherapy (NACT). Parametria were evaluated by the giant section technique in 109 patients. In 40 of these, the superficial and deep layers of the vesicouterine ligament, the sacrouterine ligament, and the distal part of the cardinal ligament were separately evaluated. The median number of nodes removed was 48 pelvic (range 20-107) and 22 aortic (range 7-64). Positive nodes were found in 14 (21%) stage IB-IIA <4 cm and in 38 (23%) NACT-treated patients, all having pelvic node metastasis. Aortic nodes were involved in 2 (3%) and 5 (3%) patients, respectively. Solitary metastases were found in the superficial obturator (21% of stage IB-IIA <4 cm and 31% of NACT-treated positive node patients, respectively), external iliac (7 and 3%, respectively), and common iliac nodes (7 and 3%, respectively). Parametrial nodes were found in 59% of giant sections (8% metastatic). The superficial and deep layers of the vesicouterine ligament, the uterosacral ligament, and the distal part of the lateral parametrium revealed the presence of nodes in 33% (no metastatic nodes), 26% (3% metastatic), 5% (no metastatic nodes), and 70% (5% metastatic) of patients, respectively. Overall, parametrial nodes were positive in 12% of stage IB-IIA <4 cm and 7% of NACT-treated patients. The diameter of node metastasis was <10 mm in more than 80% of positive nodes. In conclusion, parametrial nodes were mainly located in the cardinal and vesicouterine ligaments, both being a potential site of metastasis. The superficial obturator, external iliac, common iliac, paracaval, intercavoaortic, and paraaortic nodes were the groups more frequently involved. These data may be useful for tailoring radical hysterectomy and lymphadenectomy according to the primary tumor and the surgeon's intent.
为评估宫颈癌的淋巴转移模式，对66例国际妇产科联盟（FIGO）分期为IB-IIA期且肿瘤直径<4 cm的患者以及159例分期为IB-IIA期且肿瘤直径>4 cm至IV期的患者进行了根治性子宫切除术及系统性淋巴结清扫术。后一组患者接受了新辅助化疗（NACT）。采用大体切片技术对109例患者的宫旁组织进行了评估。其中40例患者分别对膀胱子宫韧带的浅层和深层、骶子宫韧带以及主韧带远端进行了评估。切除淋巴结的中位数为盆腔淋巴结48枚（范围20 - 107枚），主动脉旁淋巴结22枚（范围7 - 64枚）。在肿瘤直径<4 cm的IB-IIA期患者中有14例（21%）发现阳性淋巴结，在接受NACT治疗的患者中有38例（23%）发现阳性淋巴结，所有阳性患者均有盆腔淋巴结转移。主动脉旁淋巴结转移的患者分别为2例（3%）和5例（3%）。孤立转移灶分别在闭孔浅淋巴结（分别占肿瘤直径<4 cm的IB-IIA期患者的21%和接受NACT治疗且有阳性淋巴结患者的31%）、髂外淋巴结（分别为7%和3%）以及髂总淋巴结（分别为7%和3%）中发现。59%的大体切片中发现宫旁淋巴结（8%有转移）。膀胱子宫韧带的浅层和深层、骶子宫韧带以及侧宫旁组织远端发现有淋巴结的患者分别占33%（无转移淋巴结）、26%（3%有转移）、5%（无转移淋巴结）和70%（5%有转移）。总体而言，肿瘤直径<4 cm的IB-IIA期患者中12%宫旁淋巴结阳性，接受NACT治疗的患者中7%宫旁淋巴结阳性。超过80%的阳性淋巴结转移灶直径<10 mm。总之，宫旁淋巴结主要位于主韧带和膀胱子宫韧带，二者均为潜在的转移部位。闭孔浅淋巴结、髂外淋巴结、髂总淋巴结、腔静脉旁淋巴结、腔静脉间淋巴结和主动脉旁淋巴结是较常受累的淋巴结组。这些数据可能有助于根据原发肿瘤情况及外科医生的意图来调整根治性子宫切除术和淋巴结清扫术。
