163 Pathological assessment of lymph node status in cervical cancer: complete embedding does not does not yield more node metastases

Introduction/Background* Assessment of lymph node status is essential in patients with cervical cancer, particularly to determine prognosis and further therapy. The current pathological protocol states that only tissue with visible or palpable lymph nodes is investigated, the residual fatty tissue is stored. We determined in a retrospective cohort study the value of embedding and examining all removed tissue, compared to the current pathological protocol. Methodology Patients surgically treated (radical hysterectomy and pelvic lymph node dissection) for early stage cervical cancer at the Erasmus MC between 2017 and 2019 were included. In a multivariate analysis the extra lymph node count is compared to BMI and initial lymph node count. Result(s)* Ninety-eight patients were included, the residual fatty tissue was assessed in 50 (51%). The median number of lymph nodes found by conventional pathological assessment was 26 (range 9-58) and 9 (range 0-28) in the residual fatty tissue. Ten patients (10.2%) had positive lymph nodes, all were found during conventional pathological assessment. In patients with a BMI above 30 kg/m2, more lymph nodes are detected in the residual fatty tissue, compared to patients with a BMI under 30 kg/m2 (R2=0.265). The calculated extra costs of assessment of the rest fatty tissue is €240. Conclusion* Assessment of the residual fatty tissue results in the finding of 30% more lymph nodes. This did not result in the detection of more lymph node metastases. We do think it is worthwhile to investigate the residual fatty tissue in women with a high BMI (>30 kg/m2).