The utility of immunocytochemistry in invasive adenocarcinoma of the cervix (original) (raw)
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Obstetrics & Gynecology, 2004
Despite histologically negative lymph nodes, approximately 15% of patients with early-stage cervical cancer will develop recurrence. Micrometastases have been shown to be important in staging and treatment of breast cancers and melanoma and have been identified by polymerase chain reaction analysis in cervical cancers. This study sought to estimate the frequency of micrometastases identified by immunohistochemistry in histologically negative lymph nodes and compare this to other known risk factors for recurrence of cervical cancer. METHODS: Early-stage (stages IA2, IB1, and IB2) cervical cancer patients of all histologic subtypes were identified from the surgical logs of the Los Angeles County-University of Southern California Medical Center for the period 1994-2000. One hundred thirty-two patients had histologically negative lymph nodes. Immunohistochemical assay was performed on 3,106 lymph nodes by using antibodies against cytokeratins AE-1 and CAM 5.2 in combination according to standard protocols. The stained nodes were then evaluated for the presence of micrometastases and compared against the respective clinicopathologic information in each case. RESULTS: Micrometastases were detected in 19 of 132 (15%, 95% confidence interval ͓CI͔ 9%, 22%) patients, found in 29 of the 3,106 (0.9%) lymph nodes evaluated. Vascular space invasion was seen in 50 of 132 cases (38%, 95% CI 30%, 47%) and in 8 of 19 (42%, 95% CI 21%, 66%) cases with micrometastases. Surgical margins of the resected specimen were negative in 120 of 132 cases (91%, 95% CI 84%, 95%) and in 16 of 19 (84%, 95%CI 60%, 96%) of those cases with micrometastases. Micrometastases were seen most frequently in pelvic lymph nodes (25 of 29, 86%). Patients with more than 20 lymph nodes removed were more likely to demonstrate metastasis (P < .001). There was no statistically significant association between micrometastasis and vascular space invasion or tumor volume. CONCLUSION: Micrometastases are identifiable in histologically negative lymph nodes in 15% (95% CI 9%, 22%) of early-stage cancer patients, a frequency which approximates the recurrence rate for patients with negative nodes. In this series, patients with greater numbers of lymph nodes analyzed were more likely to have lymph node micrometastasis identified. There appears to be no relationship between tumor volume and the identification of micrometastases. Although micrometastases can be identified in histologically negative lymph nodes, their presence is not strongly associated with other known factors of cervical cancer recurrence. Further research is needed to determine whether the presence of lymph node micrometastases is associated with an unfavorable prognosis.
Serum in cervical cancer patients
European Journal of Cancer, 1997
Cytokeratins are polypeptides which constitute a subclass of intermediate filaments in epithelial cells. The serum tumour marker M3/M21 is based on monoclonal antibodies against the epitopes M3 and M21 of cytokeratin 18. In the present study, we measured M3/M21 serum levels in 50 patients with FIG0 stage IB-IIB cervical cancer and in 50 control subjects using a two-site radiometric immunoassay directed against soluble fragments of cytokeratin 18. Median serum levels of M3/M21 in patients with cervical cancer and in normal controls were 70.6 U/ml (range O-397.7) and 6.5 U/ml (range O-205.2), respectively (Mann-Whitney U-test, P = 0.0001). Median serum levels of M3/M21 prior to therapy and 4 weeks after therapy were 104.2 U/ml (range 24.6-397.7) and 39.
American Journal of Obstetrics and Gynecology, 1991
Serum levels of squamous cell carcinoma antigen were measured in 688 samples from 119 patients with cervical cancer. Ninety-seven patients had primary tumors and 22 had recurrent disease. Serum samples were obtained before each cycle of chemotherapy, before surgery, at least 4 weeks after surgery, and at 2-to 3-month intervals during follow-up from 78 of the patients with locally advanced cervical cancer who were receiving neoadjuvant chemotherapy. Squamous cell carcinoma antigen serum levels were elevated (>2.5 ng/ml) in 71% of the patients with primary tumors and in 77% of the patients with recurrent carcinomas. The percentage of positivity increased significantly with stage (p = 0.03) and was higher in squamous cell tumors than in adenocarcinomas (p < 0.001). Pretreatment squamous cell carcinoma antigen levels were not predictive of neoadjuvant chemotherapy response; however, the serial measurement during chemotherapy showed a good correlation with clinical response. In the patients who had surgery, squamous cell carcinoma antigen positivity did not correlate to pathologic findings (lymph node status, cervical and parametrial infiltration). Disease-free survival was significantly longer in patients with squamous cell carcinoma antigen pretreatment values that were lower than 5 ng/ml, compared with patients with marker higher than 5 ng/ml (p < 0.01). Abnormal squamous cell carcinoma antigen serum levels preceded the clinical detection of recurrence in eight of 11 patients with a median lead time of 5 months. (AM J OBSTET GVNECOL 1991;164:631-6.)
Lymph node micrometastases in initial stage cervical cancer and tumoral recurrence
International Journal of Gynecology & Obstetrics, 2015
To evaluate the prevalence of micrometastases in lymph node tissue of patients with stage Ib1-IIA cer-19 vical cancer, the correlation of micrometastases with tumor recurrence and survival, and the expression of D2-40 20 in the primary tumor of patients with recurrence and/or micrometastases and its correlation with histopathologic 21 findings.Methods: In a retrospective study, the medical records of all patients with cervical cancer treated at a hos-22 pital in São Paulo, Brazil, between 2001 and 2007 were reviewed. Patients with no lymph node metastases and 23 treated with radical hysterectomy without adjuvant treatment were included. Tumor sections were reviewed 24 and lymph nodes were analyzed with AE1/AE3. Patients with and without recurrence were compared. The pres-25 ence of lymph node micrometastasis or isolated tumor cells was also evaluated.Results: Of the 83 patients evalu-26 ated, 15 (18%) had recurrence. Significant differences between patients with and without recurrence were 27 observed with regard to tumor greatest axis, clinical stage, number of micrometastases, and negative lymph 28 nodes (P ≤ 0.04). Lymph node micrometastases and isolated tumor cells were significantly different for a stromal 29 invasion depth greater than 2/3 (P = 0.046).Conclusion: The presence of lymph node micrometastases is an 30 important risk factor for tumor recurrence. These patients should be considered eligible for adjuvant 31 radiochemotherapy treatment.
The importance of immunocytochemistry in the detection of high-grade cervical lesions
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie, 2017
Despite the implementation of various screening programs in many countries, cervical cancer continues to be a major health problem. Cervical cytology is the most used screening method, but human papillomavirus (HPV) genotyping, alone or in combination with cytology, has gained ground during the last years. Still, one of the major limitations of HPV-genotyping is the low specificity of HPV as a screening method in young women that are HPV-positive, but with no potential for future disease. Obviously, there is a need for a better screening algorithm. The ideal screening test for cervical high-grade lesions should detect the effect of high-risk (HR)-HPV infection after cell transformation, but not before, and should accurately identify the cases that are more likely to experience disease progression to neoplasia. Solid data regarding the benefit of immunocytochemistry in the evaluation of the patients with modified cervical cytology have been published recently. The use of the dual sta...
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2013
The regional failure after comprehensive clearance of neck metastasis and consequent pathological report of N0 disease has been reported fairly frequently. The role of recurrence of disease in the neck in the cases has been variously reported by different authors. The light microscopy does not detect the micrometastasis and the specimen is reported negative for metastasis. The presence of micrometastasis (the reason for neck failure) has been reported by many studies as 5-58 % (mean 19.6 %). These figures are significantly high. The present study was done to ascertain the micrometastasis after comprehensive neck clearance (pN0 report). Two groups of patients were included in this study. (1) Group I included patients with N0 necks (80 patients). (2) Group II included Patients with N+ necks (107 patients). We found that 20 % case were reported N0 (Group I) in light microscopy but on immunohistochemistry these were positive for disease. 15 % upstaging was reported in N+ cases (Group 2)...
International Journal of Biological Markers, 2013
the 14 sub-fractions of antigens associated with tumors (TA-4), the SCC-Ag is a glycoprotein with a molecular weight of 48 kDa. The SCC-Ag belongs to the serine proteinase inhibitor family, encoded by 2 high homogeneous genes, SCCA1 and SCCA2 (4, 5). SCCA1 and SCCA2 play a key role in the process of tumor development, suppressing apoptosis in human tumor cells (6, 7). Their expression is enhanced in all squamous cell carcinomas (uterine cervix, lung, head and neck, esophagus and anal canal) as well as in several non-malignant skin disorders and renal failure (8-13). Different studies showed that serum SCC-Ag concentrations correlate with tumor stage and reflect the extent of the disease. Moreover, the marker is useful to predict the response to therapy and to detect disease recurrence or progression (14-20). The use of SCC-Ag during regular monitoring of patients requires that the system used for its determination is stable over time, with low analytical imprecision. Moreover, evaluating the comparability of the 2 systems under consideration is of utmost importance in case of a method change.