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The role of lymph nodes in cervical cancer: incidence and identification of lymph node metastases—a literature review

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Abstract

Correct identification of patients with lymph node metastasis from cervical cancer prior to treatment is of great importance, because it allows more tailored therapy. Patients may be spared unnecessary surgery or extended field radiotherapy if the nodal status can be predicted correctly. This review captures the existing knowledge on the identification of lymph node metastases in cervical cancer. The risk of nodal metastases increases per 2009 FIGO stage, with incidences in the pelvic region ranging from 2% (stage IA2) to 14–36% (IB), 38–51% (IIA) and 47% (IIB); and in the para-aortic region ranging from 2 to 5% (stage IB), 10–20% (IIA), 9% (IIB), 13–30% (III) and 50% (IV). In addition, age, tumor size, lymph vascular space invasion, parametrial invasion, depth of stromal invasion, histological type, and histological grade are reported to be independent prognostic factors for the risk of nodal metastases. Furthermore, biomarkers can contribute to predict a patient’s nodal status, of which the squamous cell carcinoma antigen (SCC-Ag) is currently the most widely used in squamous cell cervical cancer. Still, pre-treatment lymph node assessment is primarily performed by imaging, of which diffusion-weighted magnetic resonance imaging has the highest sensitivity and 2-deoxy-2-[18F]fluoro-D-glucose positron emission computed tomography the highest specificity. Imaging results can be combined with clinical parameters in nomograms to increase the accuracy of predicting positives nodes. Despite all the progress regarding pre-treatment prediction of lymph node metastases in cervical cancer in recent years, prediction rates are not robust enough to safely abandon surgical staging of the pelvic or para-aortic region yet.

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Acknowledgements

Anje M. Spijkerboer has given advice on the manuscript content regarding radiology.

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This research received no external funding.

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Authors and Affiliations

  1. Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands

    Ester P. Olthof, Maaike A. van der Aa & Hans H. B. Wenzel

  2. Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Judit A. Adam

  3. Department of Radiation Oncology, Amsterdam University Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Lukas J. A. Stalpers

  4. Department of Gynaecological Oncology, Amsterdam University Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Jacobus van der Velden & Constantijne H. Mom

  5. Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Postbus 19079, 3501 DB, Utrecht, The Netherlands

    Ester P. Olthof

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  1. Ester P. Olthof
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  2. Maaike A. van der Aa
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Contributions

CM, MA and JV are responsible for the conceptualization of the manuscript. EO performed the literature search, data analysis and wrote the first draft. MA, JA, LS, JV, HW and CM critically revised the manuscript and contributed to the final draft.

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Correspondence to Ester P. Olthof.

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Olthof, E.P., van der Aa, M.A., Adam, J.A. et al. The role of lymph nodes in cervical cancer: incidence and identification of lymph node metastases—a literature review. Int J Clin Oncol 26, 1600–1610 (2021). https://doi.org/10.1007/s10147-021-01980-2

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