Correct identification of patients with lymph node metastasis from cervical cancer prior to treatment is of great importance, because it allows more tailored therapy. Patients may be spared unnecessary surgery or extended field radiotherapy if the nodal status can be predicted correctly. This review captures the existing knowledge on the identification of lymph node metastases in cervical cancer. The risk of nodal metastases increases per 2009 FIGO stage, with incidences in the pelvic region ranging from 2% (stage IA2) to 14–36% (IB), 38–51% (IIA) and 47% (IIB); and in the para-aortic region ranging from 2 to 5% (stage IB), 10–20% (IIA), 9% (IIB), 13–30% (III) and 50% (IV). In addition, age, tumor size, lymph vascular space invasion, parametrial invasion, depth of stromal invasion, histological type, and histological grade are reported to be independent prognostic factors for the risk of nodal metastases. Furthermore, biomarkers can contribute to predict a patient’s nodal status, of which the squamous cell carcinoma antigen (SCC-Ag) is currently the most widely used in squamous cell cervical cancer. Still, pre-treatment lymph node assessment is primarily performed by imaging, of which diffusion-weighted magnetic resonance imaging has the highest sensitivity and 2-deoxy-2-[¹⁸F]fluoro-D-glucose positron emission computed tomography the highest specificity. Imaging results can be combined with clinical parameters in nomograms to increase the accuracy of predicting positives nodes. Despite all the progress regarding pre-treatment prediction of lymph node metastases in cervical cancer in recent years, prediction rates are not robust enough to safely abandon surgical staging of the pelvic or para-aortic region yet.

在治疗前正确识别宫颈癌淋巴结转移患者非常重要，因为它允许更有针对性的治疗。如果可以正确预测淋巴结状态，患者可以免于不必要的手术或扩大野放疗。本综述收集了有关宫颈癌淋巴结转移识别的现有知识。淋巴结转移的风险每 2009 年 FIGO 分期都会增加，骨盆区域的发生率从 2%（IA2 期）到 14-36%（IB）、38-51%（IIA）和 47%（IIB）不等；在主动脉旁区域，范围从 2% 到 5%（IB 期）、10% 到 20% (IIA)、9% (IIB)、13% 到 30% (III) 和 50% (IV)。此外，年龄、肿瘤大小、淋巴血管间隙浸润、宫旁浸润、间质浸润深度、组织学类型、据报道，组织学分级是淋巴结转移风险的独立预后因素。此外，生物标志物可以有助于预测患者的淋巴结状态，其中鳞状细胞癌抗原 (SCC-Ag) 是目前最广泛用于鳞状细胞宫颈癌的。尽管如此，治疗前淋巴结评估主要通过影像学进行，其中弥散加权磁共振成像具有最高的灵敏度和 2-脱氧-2-[¹⁸ F]氟-D-葡萄糖正电子发射计算机断层扫描特异性最高。成像结果可以与列线图中的临床参数相结合，以提高预测阳性节点的准确性。尽管近年来在宫颈癌淋巴结转移的治疗前预测方面取得了所有进展，但预测率还不足以安全地放弃盆腔或主动脉旁区域的手术分期。