A comparison of MRI and PET scanning in surgically staged loco-regionally advanced cervical cancer: Potential impact on treatment

2001 ◽  
Vol 11 (4) ◽  
pp. 263-271 ◽  
Author(s):  
K. Narayan ◽  
R. J. Hicks ◽  
T. Jobling ◽  
D. Bernshaw ◽  
A. F. Mckenzie
Keyword(s):  
Cervical Cancer ◽  
Primary Tumor ◽  
Locally Advanced ◽  
Surgical Staging ◽  
Advanced Cervical Cancer ◽  
Nodal Disease ◽  
Predictive Values ◽  
Pet Scanning ◽  
Impact On Treatment ◽  
Potential Impact

Abstract.Narayan K, Hicks RJ, Jobling T, Bernshaw D, McKenzie AF. A comparison of MRI and PET scanning in surgically staged loco-regionally advanced cervical cancer: Potential impact on treatment.The aim of this study was to assess whether positron emission tomography (PET) or magnetic resonance imaging (MRI) could obviate the need for surgical staging in patients with locally advanced cervical carcinoma being planned for radiotherapy (RT). Imaging findings were compared to surgical staging in 27 patients including three with recent resection of the primary tumor. Both PET and MRI visualized all 24 residual cervical tumors. Primary tumor volume, as measured by MRI scan, ranged from 1.25 cc to 140 cc. In 24 patients evaluable for pelvic nodal status, PET had sensitivity, specificity, and positive and negative predictive values of 83%, 92%, 91% and 85%, respectively, with 88% accuracy. MRI detected only six in 12 (50%) patients with confirmed pelvic nodal disease, all of which were also seen by CT and PET, with an overall accuracy of 75%. PET detected only four in seven (57%) cases with confirmed para-aortic (PA) involvement. All histologically confirmed sites not visualized on PET were <1 cm. Without surgical staging, six in 10 (60%) patients with histologically proven pelvic nodal disease would not have received pelvic boost if guided by MRI alone, compared to two in 10 (20%) patients guided by PET alone or in combination with MRI. All four patients with positive PA on PET were confirmed on histology or clinical follow-up, including one case that proved to be a false negative one on surgery . However, in three cases, PET would have yielded an inadequate radiation volume. In conclusion, the positive predictive value of PET in the pelvis and para-aortic region appears sufficient to obviate lymph nodal sampling, but sampling is still required to exclude small-volume disease cranial to sites of abnormality on PET. MRI has insufficient accuracy for nodal staging to impact management.

scholarly journals Anatomic Location of PET-Positive Aortocaval Nodes in Patients with Locally Advanced Cervical Cancer: Implications for Surgical Staging

2012 ◽  
Vol 22 (7) ◽  
pp. 1203-1207 ◽  
Author(s):  
Michael Frumovitz ◽  
Pedro T. Ramirez ◽  
Homer A. Macapinlac ◽  
Ann H. Klopp ◽  
Alpa M. Nick ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Randomized Study ◽  
Locally Advanced ◽  
Stage Iv ◽  
Surgical Staging ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Pathologic Evaluation ◽  
Positron Emission ◽  
Number Of Patients

ObjectivePathologic evaluation of aortocaval nodes in patients with locally advanced cervical cancer in an effort to better tailor radiotherapy has gained popularity. We sought to determine which aortocaval nodes should be sampled during surgical staging procedures.MethodsFrom 2004 to 2011, 246 patients with locally advanced cervical cancer underwent positron emission tomography (PET) before definitive chemoradiation. We reviewed the imaging studies to determine the location of PET-positive aortocaval nodes in relationship to the inferior mesenteric artery (IMA).ResultsForty-two patients (17%) had PET images suggesting aortocaval metastasis. Ten patients had stage IB, 1 had stage IIA, 13 had stage IIB, 13 had stage IIIB, and 5 had stage IV disease. Of these 42 patients, 39 (93%) had FDG-avid pelvic nodes, 1 (2%) had PET-negative pelvic nodes but FDG-avid common iliac nodes, and 2 (5%) had direct spread to the aortocaval nodes. Three patients (7%) had FDG-avid aortocaval nodes above the IMA without FDG-avid nodes between the aortic bifurcation and IMA. All 3 of these patients also had FDG-avid nodes in the pelvis. Nineteen patients (45%) had FDG-avid nodes above and below the IMA, and 20 (48%) had FDG-avid nodes below the IMA only.ConclusionsThis hypothesis-generating study revealed that a small number of patients have PET-positive aortocaval nodes above the IMA only. For patients undergoing surgical staging for locally advanced cervical cancer, dissection to the renal vessels may be necessary. A future international, randomized study will prospectively evaluate the locations of pathologically positive aortocaval lymph nodes.

How should we stage and tailor treatment strategy in locally advanced cervical cancer? Imaging versus para-aortic surgical staging

2020 ◽  
Vol 30 (9) ◽  
pp. 1434-1443
Author(s):  
Alejandra Martinez ◽  
Martina Aida Angeles ◽  
Denis Querleu ◽  
Gwenael Ferron ◽  
Christophe Pomel
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Locally Advanced ◽  
Surgical Staging ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Node Metastasis ◽  
Pet Ct

Para-aortic lymph node status at initial assessment is the most important prognostic factor and a key point for the therapeutic strategy in patients with locally advanced cervical cancer. Undiagnosed lymph node metastasis is a major clinical problem as the finding of positive para-aortic lymph nodes leads to treatment modification, with a possible impact on disease free survival. When aortic lymph node disease is discovered, radiotherapy is extended to the para-aortic area, and other treatment modalities may be considered. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is the most accurate imaging examination to assess para-aortic extension in patients with locally advanced cervical cancer. The gold standard to identify para-aortic extension remains histologic evaluation of the lymph nodes. Indeed, PET/CT fails to detect approximately 10–15% of patients with negative PET/CT aortic nodes who have lymph node metastasis on pathologic staging. Patients with positive pelvic lymph nodes have para-aortic extension in 25–30% of cases, and surgical staging will lead to treatment modification and probably to improved para-aortic and distant control. Surgical staging also avoids unnecessary toxicity associated with extended field radiation in approximately 75% of patients with pelvic lymph node metastasis. The best modality to identify para-aortic extension is histological evaluation of the lymph nodes, but the survival benefit of surgical staging remains controversial. On the other hand, current studies include a majority of patients without pelvic lymph node spread, who are likely to be those who will benefit the least from surgical staging.

Para-aortic lymph node metastases in locally advanced cervical cancer: Comparison between surgical staging and imaging

2015 ◽  
Vol 138 (2) ◽  
pp. 299-303 ◽  
Author(s):  
Armin Vandeperre ◽  
Erik Van Limbergen ◽  
Karin Leunen ◽  
Philippe Moerman ◽  
Frédéric Amant ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Locally Advanced ◽  
Surgical Staging ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Aortic Lymph Node ◽  
Node Metastases

Impact of surgical staging in locally advanced cervical cancer and subsequent chemotherapy

2009 ◽  
Vol 100 (6) ◽  
pp. 505-510 ◽  
Author(s):  
Heitor Ricardo Cosiski Marana ◽  
Jurandyr Moreira de Andrade ◽  
Francisco José Cândido dos Reis ◽  
Daniel Guimarães Tiezzi ◽  
Fábio Eduardo Zola ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Locally Advanced ◽  
Surgical Staging ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer

Prognostic Impact of Pretreatment Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography SUVmax in Patients With Locally Advanced Cervical Cancer

2018 ◽  
Vol 28 (3) ◽  
pp. 575-580 ◽  
Author(s):  
Simona Cima ◽  
Anna Myriam Perrone ◽  
Paolo Castellucci ◽  
Gabriella Macchia ◽  
Milly Buwenge ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Primary Tumor ◽  
Fdg Pet ◽  
Locally Advanced ◽  
Emission Tomography ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Positron Emission ◽  
Pet Ct ◽  
Fdg Pet Ct

ObjectiveThe aim of this study was to investigate the impact of SUVmax fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) measured in the primary tumor, pelvic and para-aortic node with disease-free survival (DFS) and overall survival (OS) in patients with locally advanced cervical cancer.Methods and MaterialsA total of 92 patients with histological diagnosis of locally advanced cervical cancer are treated with radiochemotherapy plus brachytherapy boost from January 2008 to April 2014 in our Institution. A pretreatment FDG-PET/CT for staging and radiotherapy planning was performed, and the value of SUVmax measured in primary tumor and positive nodes was related to DFS and OS.ResultsUnivariate analysis showed that DFS is related to FDG-PET/CT positive para-aortic nodes (P = 0.01), International Federation of Gynecology and Obstetrics (FIGO) stage of disease (P = 0.01), and primary tumor SUVmax (P = 0.02), and OS is related to positive para-aortic nodes (P = 0.01) and primary tumor SUVmax (P = 0.02).In multivariate analysis, DFS is modified by FDG-PET/CT positive para-aortic lymph nodes, stage and high T SUVmax (P = 0.02; P = 0.003; P = 0.04), but the only worse prognostic factor of OS is the high SUVmax in the primary tumor (P = 0.01).ConclusionsWe found that T SUVmax, stage, and para-aortic lymph node status assessed by FDG-PET were independent prognostic factors of DFS, whereas only T SUVmax correlated with OS.

Laparoscopic paraaortic surgical staging in locally advanced cervical cancer: a single-center experience

2018 ◽  
Vol 20 (11) ◽  
pp. 1455-1459 ◽  
Author(s):  
D. Vázquez-Vicente ◽  
B. Fernández del Bas ◽  
J. García Villayzán ◽  
H. A. Di Fiore ◽  
J. Luna Tirado ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Locally Advanced ◽  
Surgical Staging ◽  
Advanced Cervical Cancer ◽  
Single Center ◽  
Locally Advanced Cervical Cancer ◽  
Single Center Experience
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