Incidence, significance, and follow-up of para-aortic lymph node metastases in late invasive carcinoma of the cervix

PURPOSE: To prospectively compare positron emission tomography (PET) imaging of regional lymph node basins to sentinel node biopsy (SNB) in patients with American Joint Committee on Cancer (AJCC) stage I, II, and III melanoma localized to the skin. METHODS: Patients with cutaneous melanoma with Breslow's depth greater than 1 mm (AJCC T2-4N0M0) or localized regional cutaneous recurrence (TxN2bM0) underwent whole-body imaging of glucose metabolism with fluorodeoxyglucose (FDG) PET followed by SNB. PET scans were interpreted in a blinded fashion and compared with histologic analyses of SNB specimens and clinical follow-up examination. Nodal tumor volumes were estimated. RESULTS: Eighty-nine lymph node basins were evaluated by FDG-PET and SNB in 70 assessable patients. Eighteen patients (25.7%) had lymph node metastases at the time of FDG-PET imaging: 17 proved by SNB (24.3%) and one by follow-up examination (1.4%). Median tumor volume in positive sentinel node basins was 4.3 mm3 (range, 0.07 to 523 mm3). Sensitivity of SNB for detection of occult regional lymph node metastases was 94.4%, specificity was 100%, positive predictive value (PPV) was 100%, and negative predictive value (NPV) was 98.6%. Sensitivity of FDG-PET was 16.7%, specificity was 95.8%, PPV was 50%, and NPV was 81.9%. At a median follow-up duration of 16.6 months, seven patients (10%) developed recurrent disease. PET predicted one recurrence (14.3%) in a node basin missed by SNB. CONCLUSION: FDG-PET is an insensitive indicator of occult regional lymph node metastases in patients with melanoma because of the minute tumor volumes in this population. FDG-PET does not have a primary role for staging regional nodes in patients with clinically localized melanoma.

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Gastric cancer with para-aortic lymph node metastases: do not miss a chance of cure!

Cancer Chemotherapy and Pharmacology ◽

10.1007/s00280-014-2491-z ◽

2014 ◽

Vol 74 (2) ◽

pp. 433-434 ◽

Cited By ~ 2

Author(s):

Daniele Marrelli ◽

Maria Antonietta Mazzei ◽

Franco Roviello

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Metastases ◽

Aortic Lymph Node ◽

Node Metastases

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Pelvic Lymph Node Metastases in Early Invasive Carcinoma of the Cervix - Histopathological ‘Risk’ Factors

Australian and New Zealand Journal of Obstetrics and Gynaecology ◽

10.1111/j.1479-828x.1991.tb02775.x ◽

1991 ◽

Vol 31 (1) ◽

pp. 87-89 ◽

Cited By ~ 1

Author(s):

P. Jayalakshmi ◽

V. Sivanesarathnam

Keyword(s):

Risk Factors ◽

Lymph Node ◽

Lymph Node Metastases ◽

Invasive Carcinoma ◽

Pelvic Lymph Node ◽

Node Metastases

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Sensitivity rate of ultrasound (US)-guided fine-needle aspiration cytology (FNAC) using the Berlin morphology criteria for lymph node metastases to reduce the need for surgical sentinel node (SN) staging in melanoma.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.8535 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 8535-8535 ◽

Cited By ~ 1

Author(s):

Christiane A. Voit ◽

Alexander Christopher Jonathan Van Akkooi ◽

Saskia Gooskens ◽

Petra Siegel ◽

Gregor Schaefer-Hesterberg ◽

...

Keyword(s):

Lymph Node ◽

Clin Oncol ◽

Lymph Node Metastases ◽

High Sensitivity ◽

Needle Aspiration ◽

Tumor Burden ◽

Maximum Diameter ◽

Node Metastases ◽

Rotterdam Criteria

8535 Background: US-guided-FNAC prior to surgical SN staging is emerging as a possible cost-effective addition to the staging of melanoma patients (pts). Formerly, sensitivity (sens) rates of lymph node US in melanoma were disappointing (20–40%). The introduction of the Berlin Morphology Criteria has significantly improved sens rates for US-FNAC (J Clin Oncol 2010;28(5):847-52). The aim of the current study was to report on 1000 patients the sens, specificity (spec), positive (PPV) and negative (NPV) predictive value rates of US-FNAC from our prospective database with prolonged follow-up. Methods: Since 2001, >1000 stage I / II consecutive melanoma pts have undergone US-FNAC prior to SN. All patients underwent lymphoscintigraphy. Peripheral Perfusion (PP), Loss of Central Echoes (LCE), Balloon Shaped (BS) were the Berlin Morphology Criteria which were registered. FNAC was performed in case of presence of any of these factors. SN tumor burden was measured according to the Rotterdam Criteria. All patients underwent SN or LND in case of positive FNAC. Results: Mean/median Breslow thickness was 2.56 / 1.57 mm (0.2 – 44 mm).Mean/median follow-up was 39 / 32 months (0 – 115). Ulceration was present in 24 %. SN positivity rates were 20 % (202 / 1000). Sens was 51 %. Spec, PPV and NPV were 99%, 91% and 89%. Sensitivity was highest for T4 tumors (77%). PP, LCE, BS had sens of 69%, 24%, 25%. SN tumor burden > 1 mm in largest diameter according to the Rotterdam Criteria was identified by US-FNAC in 86%. Threshold for positive FNAC was 0.4 mm in maximum diameter. Conclusions: The new criterion of Periferal Perfusion is of key importance to achieve the high sensitivity of US-FNAC according to the Berlin Morphology Criteria (J Clin Oncol 2010; 28:847-852) to identify lymph node metastases. Especially for T4 patients and in patients with advanced SN tumor burden it can reduce significantly the need for surgical SN staging. The EORTC Melanoma Group will launch the prospective validation study, USE FNAC, in 2012.

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