Distribution Pattern of Circumflex Iliac Node Distal to the External Iliac Node Metastasis in Stage IA to IIA Cervical Carcinoma

Yin, Yue-ju MD*†; Li, Hui-qin MD†‡; Sheng, Xiu-gui PhD*†; Li, Xing-lan MD*†; Wang, Xiang MD*†

International Journal of Gynecological Cancer: June 2014 - Volume 24 - Issue 5 - p 935–940
doi: 10.1097/IGC.0000000000000138
Cervical Cancer

Objectives: This study aimed to investigate the metastatic rate of circumflex iliac node distal to the external iliac node (CINDEIN) and its associations with clinicopathological factors in patients with stage IA to IIA cervical cancer to determine whether dissection of CINDEIN had a role in surgery of these patients.

Methods: Six hundred thirty-three patients with the International Federation of Gynecology and Obstetrics stage IA to IIA cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy were retrospectively reviewed. The metastatic rate and distribution of the pelvic lymph nodes (PLNs) and CINDEINs were analyzed.

Results: The PLN metastatic rate was 25.6% (162 of 633 patients). Sixteen of 162 node-positive patients had CINDEIN metastases. Only 1 patient without PLN metastases had positive CINDEIN nodes. Univariate analysis revealed that other PLNs (including lymph nodes collected from obturator, external iliac, and internal iliac regions) and lymph vascular space involvement were the risk factors of CINDEIN metastases (P < 0.05). Other PLN metastasis (odds ratio, 50.6; 95% confidence interval, 6.6–386.7) was an independent risk factor for metastasis to CINDEIN by binary logistic regression analysis.

Conclusions: Circumflex iliac node distal to the external iliac node metastases seemed to occur secondarily to widespread PLN metastases. In early stage cervical cancer, removal of the CINDEIN as a routine surgical procedure might be omitted to reduce operation time and minimize surgical morbidity.

*Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute; †School of Medicine and Life Sciences, University of Jinan - Shandong Academy of Medical Sciences; and ‡Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, People’s Republic of China.

Address correspondence and reprint requests to Xiu-gui Sheng, PhD, Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, 440 Jiyan Rd, Huaiyin District, Jinan 250117, Shandong Province, People’s Republic of China. E-mail: jnsxg@hotmail.com.

The authors declare no conflicts of interest.

Yue-ju Yin and Hui-qin Li equally contributed to this work.

Received January 14, 2014

Accepted March 2, 2014

© 2014 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.