The risk of lymph node metastasis in the new FIGO 2018 stage IA cervical cancer with >7 mm diameter - Original Article

Sep 24, 2026

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Objective: Determine lymph node metastasis (LNM) incidence and its associations in cervical cancers newly classified as FIGO 2018 stage IA (≤5 mm depth of invasion, DOI; diameter >7 mm) where LNM risk is unclear. Methods: Retrospective cohort of women with FIGO 2009 IB cervical cancer meeting inclusion criteria, treated by radical hysterectomy and pelvic lymphadenectomy (1985–2020); expert pathologists revised specimens; logistic regression calculated odds ratios. Results: 10/389 had confirmed LNM (2.6%); LNM associated with LVSI, not with clinical visibility. Conclusion: Consider pelvic lymph node assessment when DOI >3 mm and/or LVSI is present.

LanguageEnglish

CategoryHealthcare

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Pages11

Reading Time28 min

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Abstract

Objective

Methods

Results

Conclusion

Introduction

FIGO staging update and rationale

J Gynecol Oncol. 2023 Nov;34(6):e75 [https://doi.org/10.3802/jgo.2023.34.e75](https://doi.org/10.3802/jgo.2023.34.e75)[ ](https://doi.org/10.3802/jgo.2023.34.e75)pISSN 2005-0380·eISSN 2005-0399 Original Article Received: Nov 28, 2022 Revised: May 15, 2023 Accepted: Jun 22, 2023 Published online: Jul 7, 2023 Correspondence to Constantijne H. Mom Department of Gynecological Oncology, Amsterdam University Medical Center, PO box 22660, 1100 DD Amsterdam Zuidoost, The Netherlands. Email: [c.mom@amsterdamumc.nl](c.mom@amsterdamumc.nl) © 2023. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology, and Japan Society of Gynecologic Oncology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ([https://](https://)[ ](https://)[creativecommons.org/licenses/by-nc/4.0/](creativecommons.org/licenses/by-nc/4.0/)) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ORCID iDs Laure Nicolai [https://orcid.org/0000-0003-3705-7900](https://orcid.org/0000-0003-3705-7900)[ ](https://orcid.org/0000-0003-3705-7900)Refika Yigit [https://orcid.org/0000-0001-7379-2203](https://orcid.org/0000-0001-7379-2203)[ ](https://orcid.org/0000-0001-7379-2203)Maaike C.G. Bleeker [https://orcid.org/0000-0001-9610-8064](https://orcid.org/0000-0001-9610-8064)[ ](https://orcid.org/0000-0001-9610-8064)Joost Bart [https://orcid.org/0000-0002-0985-071X](https://orcid.org/0000-0002-0985-071X)[ ](https://orcid.org/0000-0002-0985-071X)Jacobus van der Velden [https://orcid.org/0000-0002-5985-1163](https://orcid.org/0000-0002-5985-1163) The risk of lymph node metastasis in the new FIGO 2018 stage IA cervical cancer with >7 mm diameter Laure Nicolai ,1 Refika Yigit ,2 Maaike C.G. Bleeker ,3 Joost Bart ,4 Jacobus van der Velden ,1 Constantijne H. Mom 1 1Amsterdam UMC location University of Amsterdam, Center for Gynecological Oncology, Amsterdam, The Netherlands 2University of Groningen, University Medical Center Groningen, Department of Gynecological Oncology, University Medical Center Groningen, Groningen, The Netherlands 3Amsterdam UMC location University of Amsterdam, Gynecological Pathology, Amsterdam, The Netherlands 4University of Groningen, University Medical Center Groningen, Department of Pathology, University Medical Center Groningen, Groningen, The Netherlands ABSTRACT Objective: In the 2018 FIGO staging system, cervical cancers with ≤5 mm depth of invasion (DOI) and a diameter of >7 mm, first classified as stage IB, are classified as stage IA. In this group, it is unclear what the risk of lymph node metastasis (LNM) is. This retrospective cohort study aims to determine the incidence of LNM and to study the association between disease-related characteristics and LNM. Methods: Women diagnosed with FIGO 2009 IB cervical cancer, with ≤5 mm DOI and a diameter >7 mm, treated with a radical hysterectomy and pelvic lymphadenectomy between 1985 and 2020 were selected from the databases ofthe Amsterdam University Medical Center and the University Medical Center Groningen. The specimens of patients with LNM were revised by expert pathologists. The incidence of LNM was calculated. The associations between LNM and DOI, diameter, histological type, clinical visibility and lymphovascular space invasion (LVSI) were evaluated by calculating odds ratios using logistic regression. Results: Of the 389 patients included, 10 had pathologically confirmed LNM (2.6%, 95% confidence interval=1.3%–4.5%). In case of LVSI, univariate analysis showed an increased risk of LNM (p=0.003 and p=0.012, respectively) . No difference in LNM was found between lesions diagnosed by microscopy and clinically visible lesions. No LNM were found inpatients without LVSI and a DOI of ≤3 mm. Conclusion: For patients with stage IA cervical cancer with a diameter >7 mm, we recommend consider

FAQs

What patient group was analyzed in this study?

Women with cervical cancer classified as FIGO 2018 stage IA defined by ≤5 mm depth of invasion (DOI) and tumor diameter >7 mm.

How often did lymph node metastasis occur?

Among 389 included patients, 10 had pathologically confirmed LNM, for an incidence of 2.6% (95% CI 1.3%–4.5%).

Which factors were associated with lymph node metastasis?

LNM risk increased with lymphovascular space invasion (LVSI) in univariate analysis, while no difference in LNM was found between microscopy-diagnosed lesions and clinically visible lesions.

Sep 24, 2026

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