Abstract
Purpose
To assess the clinical benefit of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG-PET/CT) in evaluating pelvic lymph nodes in patients with early stage cervical cancer (FIGO stage 1a–1b1), who have magnetic resonance imaging (MRI)-defined lymph node negative disease, with histopathologic results as the reference standard.
Materials and Methods
We assessed one hundred and seventy nine sequential 18F-FDG-PET/CT scans in women with newly diagnosed cervical carcinoma between January 2009 and September 2011. 47 of these patients had early stage disease (FIGO stage 1a–1b1) with no suspicious lymph nodes on MRI. 18F-FDG-PET/CT images were analyzed and histopathological findings (pelvic lymph node resection) served as the reference standard.
Results
The median age of patients was 48 (range 22–86) years. 66 % had squamous histotype. Median number of nodes dissected per patient was 21 (range 8–47), 2 of 47 patients had nodal metastases (4.25 %). All patients in this group had no suspicious lymph nodes on 18F-FDG-PET/CT. Overall patient based sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 18F-FDG-PET/CT for detection of nodal disease were 0 %, 100 %, 0 %, 96 %, and 96 % respectively.
Conclusion
Pathologic validation of 18F-FDG-PET/CT imaging demonstrates little value for 18F-FDG-PET/CT in patients with early stage (FIGO stage 1a–1b1) MRI-defined lymph node negative cervical carcinoma. Since the likelihood of metastatic nodal disease is very low in women with stage 1a–1b1 cervical cancer, we believe that 18F-FDG-PET/CT should not have a role in the routine pre-treatment evaluation of these women.
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References
Ahmedin J, Bray F, Center M, et al. (2011) Global cancer statistics. CA Cancer J Clin 61:69–90
Pecorelli S (2009) Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 105:103–104
Landoni F, Maneo A, Colombo A, et al. (1997) Randomized study of radical surgery vs. radiotherapy for stage Ib–IIa cervical cancer. Lancet 350(9077):535–540
Peters WA III, Liu PY, Barret R 2nd, et al. (2000) Concurrent chemotherapy and pelvic radiation therapy alone as adjuvant therapy after radical surgery in high risk early stage cancer of the cervix. J Clin Oncol 18(8):1606–1613
Grigsby PW, Siegel BA, Dehdashti F (2001) Lymph node staging by positron emission tomography in patients with carcinoma of the cervix. J Clin Oncol 19:3745–3749
Scheidler J, Hricak H, Yu KK, Subak L, Segal MR (1997) Radiological evaluation of lymph node metastases in patients with cervical cancer: a meta analysis. JAMA 278:1096–1101
Chung HH, Jo H, Kang WJ, et al. (2007) Clinical impact of integrated PET/CT on the management of suspected cervical cancer recurrence. Gynecol Oncol 104(3):529–534
Yildirim Y, Sehirali S, Avci ME, et al. (2008) Integrated PET/CT for the evaluation of para-aortic nodal metastasis in locally advanced cervical cancer patients with negative conventional CT findings. Gynecol Oncol 108(1):154–159
Leblanc E, Gauthier H, Querleu D, et al. (2011) Accuracy of 18-fluro-2-deoxy-d-glucose position emission tomography in the pretherapeutic detection of occult para-aortic node involvement in patients with a locally advanced cervical carcinoma. Ann Surg Oncol 18(8):2302–2309
Mittra E, ElMaghraby T, Rodriguez CA, et al. (2009) Efficacy of 18F_FDG PET/CT in the evaluation of patients with recurrent cervical carcinoma. Eur J Nucl Med Mol Imaging 36(12):1952–1959
Bentivegna E, Uzan C, Gouy S, et al. (2010) Correlation between [18F] fluorodeoxyglucose position emission tomography scan and histology of pelvic lymph nodes in early stage cervical cancer. Anticancer Res 30(3):1029–1032
Unger JB, Ivy JJ, Ramaswamy MR, Charrrier A, Connor P (2005) Whole-body [18F] fluoro-2-deoxyglucose position-emission tomography scan staging prior to planned radical hysterectomy and pelvic lymphadenectomy. Int J Gynecol Cancer 15(6):1060–1064
Sironi S, Buda A, Picchio M, et al. (2006) Lymph node metastasis in patients with clinical early stage cervical cancer detection with integrated FDG-PET/CT. Radiology 238(1):272–279
Wright JD, Dehdashti F, Herzog TJ, et al. (2005) Preoperative lymph node staging of early stage cervical carcinoma by [18F]_fluoro_2_deoxy_d_glucose_ positron emission tomography. Cancer 104:2484–2491
Chou HH, Chang TC, Yen TC, et al. (2006) Low value of [18F]-fluoro-2-deoxy-d-glucose position-emission tomography in primary staging of early stage cervical cancer before radical hysterectomy. J Clin Oncol 24(1):123–128
Signorelli M, Guerra L, Buda A, et al. (2009) Role of the integrated FDG-PET/CT in the surgical management of patients with high risk clinical early stage endometrial cancer; detection of pelvic nodal metastases. Gynecol Oncol 115(2):231–235
Choi HJ, Roh JW, Seo SS, et al. (2006) Comparison of the accuracy of magnetic resonance imaging and positron emission tomography/computed tomography in the presurgical detection of lymph node metastases in patients with uterine cervical carcinoma: a prospective sudy. Cancer 106:914–922
Manfredi R, Gui B, Giovanzana A, et al. (2009) Localized cervical cancer (stage <IIB): accuracy of MR imaging in planning less extensive surgery. Radiol Med 114(6):960–975
Stenstedt K, Hellstrom AC, Fridsten S, Blomqvist L (2011) Impact of MRI in the management and staging of cancer of the uterine cervix. Acta Oncol 50(3):420–426
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Driscoll, D.O., Halpenny, D., Johnston, C. et al. 18F-FDG-PET/CT is of limited value in primary staging of early stage cervical cancer. Abdom Imaging 40, 127–133 (2015). https://doi.org/10.1007/s00261-014-0194-x
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DOI: https://doi.org/10.1007/s00261-014-0194-x