The lymphatic system of the uterine cervix: towards a more precise definition of the drainage routes.

PURPOSE Lymph node involvement in cervical cancer is a major independent prognostic factor for overall survival. The aim of our study was to examine the lymphatic drainage regions of the different parts of the cervix by an anatomical and radio-anatomical study. METHODSAn anatomical study of fresh cadavers was conducted by injecting patent blue in the anterior or posterior cervical lip. Drainage regions were thereby compared according to the injection sites. In parallel, a retrospective radiological and pathological study was conducted on patients who were treated for early-stage cervical cancer with lymph node involvement. Radiological analysis of pre-therapeutic MRIs and/or pathological analysis of surgical specimens showed the precise location of the tumour. A correlation between the anatomy of the primary lesion site and its lymphatic drainage was established.RESULTS We administered 8 cadaveric injections in the anterior cervical margin and 7 in the posterior cervical margin. For 100% of the anterior lip injections, lymphatic drainage was bilateral ileo-obturator (n=8/8) combined with bilateral parametrial drainage. For the posterior injections, there was never any ileo-obturator drainage, and 6 of the 7 (75%) posterior injections drained in the posterior uterine serosa. Among the 21 patients included, the radiological and pathological examination showed a non-significant tendency towards bilateral lymph node involvement when the tumour was located on the anterior cervical margin.CONCLUSIONThrough our study we were able to realize that the drainage of the cervix is not the same depending on the anterior or posterior location. This could have a major clinical interest in cervical cancer surgery.