The implementation of sentinel lymph node (SLN) biopsy is changing the scenario in the surgical treatment of early-stage cervical cancer, and the oncologic safety of replacing bilateral pelvic lymphadenectomy with SLN biopsy is currently under investigation. Part of the undisputed value of SLN biopsy is its diagnostic accuracy in detecting low-volume metastases (LVM) via pathologic ultrastaging. In early-stage cervical cancer, the reported incidence of LVM ranges from 4 to 20%. The prognostic impact and the role of adjuvant treatment in patients with LVM is still unclear. Some non-prespecified analyses in prospective studies showed no impact on the oncologic outcomes compared to node-negative disease. However, the heterogeneity of the studies, the differences in the disease stage and the use of adjuvant treatment, and the concomitant pelvic lymphadenectomy (PLND) make reaching any conclusions on this topic hard. Current guidelines suggest considering micrometastases (MIC) as a node-positive disease, while considering isolated tumor cells (ITC) as a node-negative disease with a low level of evidence. This review aims to highlight the unanswered questions about the definition, identification, and prognostic and therapeutic roles of LVM and to underline the present and future challenges we are facing. We hope that this review will guide further research, giving robust evidence on LVM and their impacts on clinical practice.
前哨淋巴结（SLN）活检的实施正在改变早期宫颈癌的手术治疗格局，而用SLN活检替代双侧盆腔淋巴结清扫术的肿瘤安全性目前仍在研究中。SLN活检无可争议的价值之一在于其通过病理超分期检测低负荷转移（LVM）的诊断准确性。在早期宫颈癌中，LVM的报道发生率介于4%至20%之间。LVM对预后的影响以及辅助治疗在LVM患者中的作用尚不明确。一些前瞻性研究中的非预设分析显示，与淋巴结阴性疾病相比，LVM对肿瘤结局没有影响。然而，研究的异质性、疾病分期和辅助治疗的差异，以及伴随的盆腔淋巴结清扫术（PLND），使得在这一主题上得出任何结论都变得困难。目前的指南建议将微转移（MIC）视为淋巴结阳性疾病，而将孤立肿瘤细胞（ITC）视为淋巴结阴性疾病，但证据级别较低。本综述旨在强调关于LVM的定义、识别、预后和治疗作用方面尚未解答的问题，并强调我们当前和未来面临的挑战。我们希望本综述能指导进一步的研究，为LVM及其对临床实践的影响提供有力证据。
肿瘤(癌症)患者之家