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Retrocrural Lymph Node Metastasis Disclosed by 18F-FDG PET/CT: A Predictor of Supra-diaphragmatic Spread in Ovarian Cancer

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Abstract

Purpose

Retrocrural lymph nodes (RCLNs) communicate with retroperitoneal and posterior mediastinal LNs. It is possible that, when RCLNs are involved, supra-diaphragmatic extension will occur in abdomino-pelvic cancers. The authors investigated performance of 18F-FDG PET/CT to diagnose RCLN metastasis and whether RCLN metastases were associated with supra-diaphragmatic lymphatic metastases of ovarian cancer.

Materials and methods

Sixty-seven patients with stage IV ovarian cancer who had undergone 18F-FDG PET/CT were included in this retrospective study. Diagnostic performance of 18F-FDG PET/CT for RCLN metastasis was evaluated. Patients were divided into two groups by presence or absence of supra-diaphragmatic LN metastasis. The prevalences of RCLN metastasis between the two groups were compared and the odds ratio was calculated.

Results

Sensitivity and specificity of 18F-FDG PET/CT for RCLN metastasis were 96.3 and 100%, respectively. Of the 67 study subjects, 27 patients had RCLN metastases (40.3%). Fifty patients had supra-diaphragmatic LN metastases. 18F-FDG PET/CT showed 26 RCLN metastases in patients with supra-diaphragmatic LN metastases (54.5%), and only 1 in patients without supra-diaphragmatic LN metastasis (5.9%), and the difference between two groups was statistically significant (P < 0.05). The odds ratio that patients with RCLN metastasis would have supra-diaphragmatic LN metastasis was 17.3 (95% confidence interval = 2.1 to 140.9, P = 0.008).

Conclusion

Performance of 18F-FDG PET/CT to diagnose RCLN metastasis was excellent. RCLN metastasis revealed by 18F-FDG PET/CT was strongly associated with supra-diaphragmatic LN spread of ovarian cancer. Thus, RCLN metastasis could be used as a predictor of supra-diaphragmatic lymphatic metastasis of ovarian cancer.

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Acknowledgments

This research was supported by grant no. R31-2008-000-10103-0 from the WCU project of the Korean Ministry of Education, Science and Technology (MEST) and the National Research Foundation of Korea (NRF). Figure 1 was illustrated and kindly provided by Doctor Yongwonn Kwon.

Conflict of interest

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Authors and Affiliations

  1. Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea

    Hyung-Jun Im, Yong-il Kim, Jin Chul Paeng, June-Key Chung & Dong Soo Lee

  2. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

    June-Key Chung

  3. Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea

    June-Key Chung & Dong Soo Lee

  4. Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea

    Soon-Beom Kang

  5. Department of Molecular Medicine and Biopharmaceutical Sciences, WCU Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea

    Hyung-Jun Im, Yong-il Kim & Dong Soo Lee

  6. 28, Yeongeon-dong, Jongno-gu, Seoul, 110-799, Korea

    June-Key Chung

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  1. Hyung-Jun Im
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  2. Yong-il Kim
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Correspondence to June-Key Chung.

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Im, HJ., Kim, Yi., Paeng, J.C. et al. Retrocrural Lymph Node Metastasis Disclosed by 18F-FDG PET/CT: A Predictor of Supra-diaphragmatic Spread in Ovarian Cancer. Nucl Med Mol Imaging 46, 41–47 (2012). https://doi.org/10.1007/s13139-011-0115-7

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  • DOI: https://doi.org/10.1007/s13139-011-0115-7

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