Discuss Of Pelvic Lymph Node Micrometastasis In Patients With Early Stage Cervical Squamous Cancer

ObjectiveTo explore the clinical significance of cytokeratin AE1/AE3 immunohistochemical staining in detecting the lymph node micrometastasis of cervical squamous cancer. This may be helpful for the treatment and prognostic evaluation.Method1．Tissue collectionWe retrospectively reviewed the medical records of 14 patients, who underwent radical hysterectomy and lymphadenectomy for FIGO (1995) stage IA-IIA cervical squamous cancer at the First Affiliated Hospital of China Medical University from January to June, 2006．All the patients were not underwent radiotherapy and chemotherapy before operation. We divided the lymph nodes into four groups when operation, the group of common iliac lymph node, external iliac lymph node, obturator lymph node and deep inguinal lymph node. A total of 246 lymph nodes were acquired. All the formalin-fixed, paraffin-embedded specimens were serially sectioned and stained with HE. A total of 228 lymph nodes were not found metastasis with HE stain.2．MethodsImmunohistochemistry (SP method) Paraffin-embedded pelvic lymphadenectomy specimens were serially sectioned and stained with anti-cytokeratin antibodies AE1/AE3．The working concentration of antibodies AE1/AE3 was 1:100．All procedures were implemented according to the product illustration. 3．Statistical AnalysisThe data were evaluated by chi-square test and Fisher's exact probabilities, SPSS 11．5．Results1．Among 228 negative lymph nodes, micrometastasis was found in 3 lymph nodes of patients with cervical squamous cancer by AE1/AE3 staining. The positive rate of micrometastasis was 21．4% (3/14, 95%CI 0．5%, 43．3%) and the positive rate of lymph nodes was 1．3% (3/228) .2．Among the lymph nodes with micrometastasis, two lymph nodes were in the external iliac lymph node group and one was in the obturator lymph node group. The detection rates of two groups were 3．8% (2/53) and 1．1% (1/87) . The incidences of micrometastasis between two groups were not significant differences. The group of common iliac lymph node and deep inguinal lymph node were not found micrometastasis.3．In some clinical features, we found the incidence of micrometastasis was related with clinical stage. The positive rate of micrometastasis increased with the progression of clinical stage (x=8．601, p<0．05) . In the other clinical features, such as tumor volume, depth of invasion, degree of differentiation, the incidence of micrometastasis was not significant differences.Conclusions1．There is micrometastasis in the pelvic lymph nodes around the early stage cervical squamous cancer, which can be detected with immunohistochemistry.2．The route of lymph nodes metastasis in cervical cancer is maybe from external iliac lymph nodes and obturator lymph nodes to next station. The positive rate of micrometastasis increased with the progression of clinical stage.3．Patients with micrometastasis should be followed-up closely, and filled up ratiotherapy and chemotherapy if necessary.