Value of laparoscopic evaluation of paraaortic and pelvic lymph nodes for treatment of cervical cancer

OBJECTIVE: Laparoscopy was used to identify and localize suspicious lymph nodes in patients with cervical cancer. STUDY DESIGN: Eighty-four patients with cervical cancer International Federation of Gynecology and Obstetrics stage 1A(2) to IV were staged by laparoscopic paraaortic and pelvic lymphadenectomy. The accuracy of laparoscopic assessment of lymph node status was compared with the histologic result. Positive lymph nodes were localized topographically by use of laparoscopy. RESULTS: Sensitivity and specificity of laparoscopic evaluation for identifying positive paraaortic and pelvic lymph nodes was 92.3%. Combination of laparoscopic evaluation and frozen section helped to diagnose all patients with involved lymph nodes correctly. In 13 of 84 (15.4%) patients the result of lymph node assessment by laparoscopic evaluation and frozen section changed primary therapy. In two of these patients one positive lymph node was located in the lateral part of the cardinal ligament, and the hysterectomy was extended to be a more radical procedure. CONCLUSIONS: Laparoscopic evaluation identified the lymph node status in patients with cervical cancer with high accuracy. Topographic localization showed that the lateral part of the cardinal ligament is involved early in lymph node spread.