Lymph node counts in uterine cancer: a randomized double blind trial.

Objective: Higher number of lymph nodes counts may suggest a more accurate cancer staging. We wish to study whether sending lymph nodes to pathologist in four containers, instead of a single container, yields a higher nodal count.

Methods: Patients with uterine cancer who underwent abdominal hysterectomy and lymphadenectomy were recruited. The right and left pelvic lymph nodes were collected from four locations (common, external and internal iliac, and obturator). Blinded randomization ex vivo allocated the side of the pelvic nodes specimen which was sent to pathology as one versus four containers. Each patient served as her own control by having the other side of her pelvic nodes sent as four different specimens. The surgeons and pathologists were blinded.

Results: 104 consecutive patients were enrolled. The average age was 61 years old. The patients were predominately Caucasians (69%). The average total pelvic and aortic nodes per patients was 17.8. 54 patients, whose right-sided pelvic nodes were randomized to be sent in a single container, yielded an average of 7.2 right pelvic nodes versus 8.6 left pelvic nodes (p=0.026). 50 patients, whose left-sided pelvic nodes were randomized to be sent in a single container, yielded an average 8.1 right pelvic nodes versus 6.9 left pelvic nodes (p=0.042).

Conclusion: The lymph nodes count are higher when surgical nodes were sent as multiple separated instead of single specimens, regardless of the side of the pelvis.