Comparison of laparoscopic sonography with surgical pathology in the evaluation of pelvic lymph nodes in women with cervical cancer

OBJECTIVE. This study compared laparoscopic sonography with surgical pathol ogy in the evaluation of pelvic lymph nodes in women with cervical cancer. SUBJECTS AND METHODS. Intraoperative laparoscopic sonography of pelvic lymp h nodes was performed in 31 women with biopsy-proven cervical cancer. A lym ph node that was rounded (longitudinal-transverse axis ratio of <2) or show ed absence of central hilum was defined as positive for metastasis. For com parison, lymph nodes from each hemipelvis were grouped anatomically into pa raaortic, common, internal, and external iliac chains during evaluation on laparoscopic sonography and on surgical pathologic examination. RESULTS. Pelvic dissection in 31 women yielded 630 lymph nodes. There were 54 metastatic nodes in 12 women. Laparoscopic sonography revealed 32 (59%) of all pathologically metastatic lymph nodes. Sensitivity on laparoscopic s onography when comparing groups by hemipelves was 93.3% and by anatomic lym ph node chains was 76.2%. Metastatic nodes were most commonly located in th e common iliac region and were characteristically rounded, hypoechoic, show ed absence of central hilum, and occasionally showed central necrosis, Nine (28%) of 32 metastatic lymph nodes revealed by laparoscopic sonography mea sured 1 cm or less. Six benign nodes in four patients were also visualized with laparoscopic sonography. CONCLUSION. Laparoscopic sonography achieved a sensitivity exceeding 90% in the detection of metastatic lymph nodes in the hemipelves of women with ce rvical cancer. Laparoscopic sonography is a feasible and promising techniqu e for the evaluation of pelvic lymph nodes in women with cervical cancer an d merits further evaluation.