Journal of Clinical Virology 50 (2011) 46–49 Contents lists available at ScienceDirect Journal of Clinical Virology journal homepage: www.elsevier.com/locate/jcv High-risk human papillomavirus DNA in paraaortic lymph nodes in advanced stages of cervical carcinoma Jiri Slama a,∗ , Marcela Drazdakova b , Pavel Dundr c , Daniela Fischerova a , Michal Zikan a , Ivana Pinkavova a , Pavel Freitag a , Michael Fanta a , David Kuzel a , Tomas Zima b , David Cibula a a General Teaching Hospital and 1st Medical School of Charles University, Department of Oncogynecology, Apolinarska 18, 128 00 Prague 2, Czech Republic b General Teaching Hospital and 1st Medical School of Charles University, Institute of Clinical Biochemistry and Laboratory Diagnostics, U Nemocnice 2, 128 00 Prague 2, Czech Republic c General Teaching Hospital and 1st Medical School of Charles University, Department of Pathology, Studnickova 2, 128 00 Prague 2, Czech Republic article info Article history: Received 21 March 2010 Received in revised form 24 September 2010 Accepted 29 September 2010 Keywords: Cervical cancer HPV Lymph node abstract Background: Paraaortic lymph nodes represent the second level in the lymphatic spread of cervical cancer. Recent studies have confirmed the association of HPV DNA in pelvic lymph nodes in early-stage disease with metastatic involvement and a less favourable prognosis. Objective: The aim of our study was to detect 13 high-risk genotypes of HPV in paraaortic nodes harvested from patients with FIGO IB2–IIIB tumours and correlate findings with histopathology. Study design: The study involved patients with advanced cervical cancer who had undergone low paraaor- tic lymphadenectomy. The cytobrush technique was used for perioperative sample collection from the tumour and fresh lymphatic tissue. Patients with non-HPV related cancers were used as a control group. Results: The study involved 24 cervical cancer patients. High-risk HPV DNA was found in the primary tumour of all cases and in PALN in 16 (67%) cases. The most frequent genotype was HPV 16, both in the tumour and in the paraaortic lymph nodes (83% and 54%, respectively). Metastatic involvement of paraaortic lymph nodes was identified in 8 cases (33%), which all were also HPV DNA positive. No HPV DNA was detected in PALN in any of 22 control group cases. Conclusions: Using the cytobrush technique, the presence of at least one HR HPV genotype in the primary tumour was identified in all the patients. The metastatically involved paraaortic lymph nodes always contained the DNA of at least one HPV genotype present in the primary tumour. Determination of clinical significance of HR HPV DNA presence in histologically negative lymph nodes requires further follow-up of the cohort. © 2010 Elsevier B.V. All rights reserved. 1. Background Almost all cases of cervical cancer are caused by human papil- lomavirus (HPV) infection. One of the most important prognostic factors in cervical cancer patients is the metastatic involvement of the lymph nodes which, depending on the stage of the dis- ease, shortens the five-year survival rate by 25–60%. 1,2 Even when lymph nodes are negative, a part of the surgically treated patients suffer from relapse of the disease. 3 One possible cause of retroperi- toneal relapses may be the presence of subclinical metastatic lymph node involvement. There have been several references in literature of high-risk (HR) HPV DNA presence in lymph nodes as a pos- sible marker of such subclinical involvement. Recent prospective ∗ Corresponding author. Tel.: +420 224967440. E-mail address: slamajiri@centrum.cz (J. Slama). studies have confirmed the simultaneous presence of HPV DNA in metastatically involved pelvic lymph nodes. 2,4–6 Paraaortic lymph nodes (PALN) represent the second level in the lymphatic spread of cervical cancer. Their metastatic involvement has been documented in about 25% of locally advanced stages. 7 Clinical staging of the PALN is a decisive parameter for the deter- mination of the extent of the radiation field. 8–10 2. Objectives No study has so far evaluated prevalence and significance of HR HPV DNA presence in the PALN in patients with advanced cervical cancer. It was the aim of our study to detect 13 HR genotypes of HPV in PALN harvested from patients with FIGO IB2–IIIB tumours and correlate findings with histology. The control group consisted of patients with non-HPV related tumours (ovarian or endometrial cancer). 1386-6532/$ – see front matter © 2010 Elsevier B.V. All rights reserved. doi:10.1016/j.jcv.2010.09.020