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Surgical-Pathologic Risk Factors and Immunohistochemical Markers of Pelvic Lymph Node Metastasis in Stage IB1 Cervical Cancer

Hernandez, Enrique MD1,2; De La Mota, José MD1; Thomas, M. Bijoy MBBS1; Huang, Yajue MD, PhD2; Gaughan, John P. PhD3; Wang, Fengwei MD2

Journal of Lower Genital Tract Disease:
doi: 10.1097/LGT.0b013e31821c97de
Original Articles

Objective: This study aimed to identify the surgical-pathologic risk factors and immunohistochemical markers of pelvic lymph node metastasis in stage IB1 cervical cancer.

Materials and Methods: A retrospective review of patients with stage IB1 cervical cancer who underwent radical abdominal hysterectomy, lymph node dissection, and immunohistochemical staining for p53, bcl-2, and Ki-67 was performed.

Results: A total of 29 patients with complete clinical data and pathology tissue blocks are the subjects of this study. Of these patients, 20 (69%) had squamous cell carcinoma, 8 (28%) had adenocarcinoma, and 1 (3%) adenosquamous carcinoma. The median tumor diameter as measured in the pathology laboratory was 2 cm. The median number of lymph nodes removed was 24. Four (14%) patients had positive lymph nodes. Lymphovascular invasion was noted in 10 (34%). None of the 19 patients without lymphovascular invasion had lymph node involvement. Of 29 patients, 2 (7%) had parametrial involvement. There was a statistically significant correlation between tumor diameter and depth of invasion (r = 0.43, p = .02), and between lymphovascular invasion and positive lymph nodes (r = 0.55, p = .0019). The Ki-67 immunostaining index was higher for patients with lymphovascular invasion and/or positive lymph nodes (p = .008 and p = .028, respectively). There was no association between p53 or bcl-2 expression and lymphovascular invasion or lymph node metastasis.

Conclusions: Lymph node metastasis (14 %) and parametrial involvement (7%) occurred only in patients with lymphovascular invasion and/or large tumor size. The Ki-67 staining index is associated with lymphovascular invasion and lymph node metastasis.

In Brief

The Ki-67 index is increased in patients with early stage cervical cancer with lymphovascular invasion and/or lymph node metastasis.

Author Information

1Department of Obstetrics, Gynecology and Reproductive Sciences, 2Department of Pathology and Laboratory Medicine, and 3Biostatistics Consulting Center, Temple University School of Medicine, Philadelphia, PA

Reprint requests to: Enrique Hernandez, MD, Department of Obstetrics and Gynecology, Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140. E-mail:

©2011The American Society for Colposcopy and Cervical Pathology