Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

Low-Volume Metastases in Cervical Cancer: Does Size Matter?

Tommaso Bianchi
ORCID logo ,
Tommaso Grassi
* ORCID logo ,
Giampaolo Di Martino
,
Serena Negri
ORCID logo ,
Gaetano Trezzi
,
Robert Fruscio
ORCID logo ,
Fabio Landoni
Version 1 : Received: 26 February 2024 / Approved: 27 February 2024 / Online: 27 February 2024 (19:22:39 CET)

A peer-reviewed article of this Preprint also exists.

Bianchi, T.; Grassi, T.; Di Martino, G.; Negri, S.; Trezzi, G.; Fruscio, R.; Landoni, F. Low-Volume Metastases in Cervical Cancer: Does Size Matter? Cancers 2024, 16, 1107. Bianchi, T.; Grassi, T.; Di Martino, G.; Negri, S.; Trezzi, G.; Fruscio, R.; Landoni, F. Low-Volume Metastases in Cervical Cancer: Does Size Matter? Cancers 2024, 16, 1107.

Abstract

The implementation of sentinel lymph node (SLN) biopsy is changing the scenario in the surgical treatment of early-stage cervical cancer and the oncologic safety of replacing bilateral pelvic lymphadenectomy with SLN biopsy is currently under investigation. One of the undisputed values of SLN biopsy is its diagnostic accuracy in detecting low-volume metastases (LVM) via pathologic ultrastaging. In early-stage cervical cancer, the reported incidence of LVM ranges from 4 to 20%. The prognostic impact and the role of adjuvant treatment in patients with LVM is still unclear. Some non-prespecified analyses in prospective studies showed no impact on the oncologic outcomes compared to node-negative disease. However, the heterogeneity of the studies, the differences in the disease stage and the use of adjuvant treatment, and the concomitant pelvic lymphadenectomy (PLND) make any conclusion on this topic hard. Current guidelines suggest considering micrometastasis (MIC) as a node-positive disease, while isolated tumor cells (ITC) as a node-negative disease, with a low level of evidence. This review aims to highlight the unanswered questions about the definition, identification, prognostic and therapeutic role of LVM and underline the present and future challenges we are facing. We hope this review will guide further research, giving robust evidence on LVM and their impact on clinical practice.

Keywords

cervical cancer; low-volume metastases; micrometastases; isolated tumor cells; ultrastaging; sentinel lymph node

Subject

Medicine and Pharmacology, Oncology and Oncogenics

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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