Site specific lymph node metastasis in carcinoma of the cervix: Is there a sentinel node?

Follow-up for at least 5 years was available for 350 cases of stage IB and IIA carcinoma of the cervix managed by radical hysterectomy and pelvic lymphadenectomy. Lymphadenectomy technique mapped the patterns of pelvic lymph node metastasis (LNM). The effects on survival of specific factors relating to the lymphadenectomy (node count, number of positive nodes, site of positive nodes, number of sites positive, location of highest positive node) were determined for 80 women with LNM. The location of metastatic disease did not significantly predict survival. The incidence of LNM was 23% and 47.5% of these women survived 5 years. Only 45% of cases with a solitary LNM survived 5 years and in 45% of these recurrence was outside the pelvis. With the exception of the presacral group, the finding of isolated LNM in any other group with metastasis to the left side of the pelvis conferred the worst prognosis. The pattern of LNM from early stage carcinoma of the cervix is therefore random and the concept of a sentinel node or group is not tenable.