Human papillomavirus DNA in tumor-free regional lymph nodes: a potential prognostic marker in cervical carcinoma.

PURPOSE

The medical management of women with cervical carcinoma would benefit from a test that might predict which patients have a high risk of progression or recurrence. The detection of micrometastases in regional lymph nodes may be such a test. At least 90% of cervical carcinomas worldwide contain human papillomavirus (HPV) DNA. In a pilot study, we evaluated a polymerase chain reaction-based method for the detection of human papillomavirus DNA in archival routine sections of regional lymph nodes as a marker of micrometastasis in patients with a long-term follow-up period.

PATIENTS AND METHODS

We analyzed 134 archival routine slides of histologically tumor-free lymph nodes derived from 21 patients with clinically and pathologically determined stage Ib, IIa, and IIb HPV-16 positive cervical carcinoma. The patients had been selected for good (still alive with a follow-up time of at least 5 years) or fatal outcome (dead of disease within 3 years). The amount of HPV-16 DNA was estimated by comparison with standards.

RESULTS

All patients without strongly HPV-positive lymph nodes survived. In contrast, 8 of 12 women with strongly HPV-positive lymph nodes died of cervical carcinoma.

CONCLUSIONS

In patients with cervical cancer, an approach based on a PCR test for HPV DNA in tumor-free regional lymph nodes may allow early identification of women at high risk for relapse who should receive adjuvant treatment.