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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: October 2011 - Volume 15 - Issue 4 - p 303-308
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.

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

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