Lymph Node Size: Does It Reflect the Status of Tumor Metastasis in Gynecologic Malignancy?

Abstract

Objective To study whether the lymph node size is a reliable indicator in determining the presence of gynecologic cancer metastasis.

Subjects Pathological specimens from four hundred and nine gynecologic cancer patients who had undergone various types of pelvic surgery that included lymph nodes resection between January 1994 and December 1999.

Method All sections of lymph nodes were reviewed and measured in two dimensions. The size of nodes were serially leveled and studied pathologically to determine the sensitivity and specificity in determining cancer metastasis.

Main outcome measures The numbers of positive and negative nodes with their sizes in two dimensions, the sensitivity and specificity of lymph nodes size in determining cancer metastasis.

Results Out of 7,260 total nodes obtained, 265 nodes (3.7%) were found to be positive for metastatic cancer. Among these positive nodes, 17 nodes (6.4 %) had nodal maximal axis of <3 mm while 141 nodes (53.2%), 81 nodes (30.6%) and 26 nodes (9.8%) had nodal maximal axis of > 3 - 10 mm, > 10 - 20 mm and > 20 mm respectively. More than half (59.6%) of these positive nodes axis were < 10 mm and most (90.2%) were s 20 mm. Based on the widely accepted size 10 mm of node as pathological enlargement, the sensitivity and specificity would be 40% and 81 % respectively.

Conclusion Evaluation of lymph node status by sampling only the enlarged nodes does not represent the true positive incidence of nodal metastasis which in turn leading to inaccurate staging and management. To avoid this kind of misclassification error, a complete lymph nodes dissection is encouraged in all patients undergoing surgical staging.