# Nodal staging score for adequacy of nodal staging in cervical cancer

## TL;DR

This study creates a nodal staging score to determine how many lymph nodes should be examined in cervical cancer patients to ensure accurate diagnosis and better prognosis.

## Contribution

The study introduces a nodal staging score (NSS) to guide the adequacy of lymph node examination in cervical cancer based on histological type.

## Key findings

- The number of lymph nodes required to reach a 0.05 false negative probability varies by histological type, ranging from 12 to 18 nodes.
- The NSS reaches 0.95 with fewer nodes in adenocarcinoma (6) compared to squamous cell carcinoma (10).
- NSS quartiles showed significant prognostic value across all four histological types of cervical cancer.

## Abstract

Cervical cancer remains the fourth most common female malignancy with increasing newly cases around the world. It is of clinical value to precisely evaluate whether false negative nodal existed and develop a nodal staging model in cervical cancer.

Clinical data of cervical cancer patients was retrieved from the Surveillance, Epidemiology, and End Results database. Probability of missing nodal disease and nodal staging score (NSS) was computed to assess the nodal status of each individual.Prognostic value of NSS was assessed.

A total of 9056 individuals were in this study, with 5115 squamous cell carcinoma, 2791 adenocarcinoma, 512 adenosquamous carcinoma, and 638 other type individuals. A beta-binomial model was used to compute the probability of nodal disease in four histological types, respectively. False negative probability drastically decreased as more nodes examined. To reach 0.05 of false negative probability, it required at least 17 lymph nodes in squamous cell carcinoma patients,18 in adenocarcinoma, 12 in adenosquamous carcinoma patients and 14 in other types. To reach 0.95 of NSS, it took 10 lymph nodes in squamous cell carcinoma, 6 in adenocarcinoma, 10 in adenosquamous carcinoma and 7 in other types. Significant prognostic values of NSS quartiles subsets were found in all four histological sets.

NSS tool enables adequate nodal staging of cervical cancer with significant prognostic value. Exact number of lymph nodes required for surgery in cervical cancer is specified based on histologic type.