HPV in Sentinel Lymph Nodes
HPV in Sentinel Lymph Nodes
This study examines sentinel lymph node tissue from early stage cervical cancer patients
 treated with radical hysterectomy and removal of pelvic sentinel lymph nodes (SLN). SLNs are
 tested for the presence of human papilloma virus (HPV), and results are compared to the
 HPV-type found in the patients cervical tissue.

 We hereby examine whether pathologic status of SLNs in patients with early-stage cervical
 cancer correlates to the HPV status in the SLNs. By means of an up to 5-years follow-up
 period, we furthermore examine whether cervical cancer recurrence correlates to the
 histopathologic status of the SLNs and/or the SLN HPV status. This will contribute to the
 clarification on whether HPV status of the SLNs plays a crucial role for predicting LN
 metastasis of cervical cancer and also, whether the HPV status in SLNs may have a clinical
 value as a prognostic factor for disease recurrence in cervical cancer patients and perhaps
 even a better clinical value than SLN mapping.
The aim of the study is to examine whether the pathologic status of SLNs in patients with
 early-stage cervical cancer correlates to the HPV status in the SLNs and also, whether
 cervical cancer recurrence correlates to the histopathologic status of the SLNs and/or the
 SLN HPV status.

 In Denmark, staging and treatment of cervical cancer are performed according to the
 recommendations of the International Federation of Gynecology and Obstetrics (FIGO). Cervical
 cancer is the only gynecological cancer that is clinically based on tumor size, vaginal or
 parametrial involvement, bladder/rectum extension and distant metastases. It requires
 examination under anesthesia and imaging, which in Denmark includes positron emission
 computed tomography (PET-CT) to detect pathological lymph nodes (LNs) and to accurately
 delineate the extent of the disease and magnetic resonance imaging (MRI) to determine tumor
 size, degree of stromal penetration, parametrial involvement, vaginal and corpus extension.
 Tumor risk assessment includes tumor size, stage, depth of tumor invasion, LN status,
 lymphovascular space invasion (LVSI) and histological subtype, of which LN status and number
 of LNs involved are the most important prognostic factors. In Denmark, patients at FIGO
 stages 1B1 to 2A undergo radical hysterectomy and radical pelvic lymphadenectomy (PL), and
 they are offered adjuvant oncological treatment with radiotherapy and concomitant
 chemotherapy if specific risk factors are present. A national protocolled study on the
 implementation of SLN mapping in women with early-stage cervical cancer is currently being
 conducted in Denmark at Rigshospitalet, Odense University Hospital and Aarhus University
 Hospital (The Sentirec study). In this study, we want to examine the remains from these
 analyzed SLNs. According to the Sentirec protocol, SLNs are examined by means of
 ultrastaging, which entails cutting the SLNs in more sections and all levels of the LN and
 examining these levels histologically by an experienced pathologist. In this study, we
 examine the remains from the SLNs; that is the sections between the tissue used for SLN
 mapping. These sections are analyzed for HPV.
Inclusion Criteria:

 -  Woman > 18 years of age diagnosed with cervical cancer and admitted for surgery with
 radical hysterectomy and removal of SLNs between October 2018 and June 2022.

 Exclusion Criteria:

 -  Woman < 18 years

 -  Women with late-stage cervical cancer, who are treated with radio- and chemotherapy.