Utility of PET-CT vs CT alone to evaluate retroperitoneal lymph node metastasis in advanced cervical cancer.

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.

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Utility of preoperative ferumoxtran-10 MRI to evaluate retroperitoneal lymph node metastasis in advanced cervical cancer: Results of ACRIN 6671/GOG 0233

European Journal of Radiology Open ◽

10.1016/j.ejro.2014.11.002 ◽

2015 ◽

Vol 2 ◽

pp. 11-18 ◽

Cited By ~ 5

Author(s):

Mostafa Atri ◽

Zheng Zhang ◽

Helga Marques ◽

Jeremy Gorelick ◽

Mukesh Harisinghani ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Advanced Cervical Cancer ◽

Retroperitoneal Lymph Node ◽

Node Metastasis

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Assessment of retroperitoneal lymph node status in locally advanced cervical cancer

BMC Cancer ◽

10.1186/s12885-021-08208-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wei Li ◽

Li Xiong ◽

Qiaoling Zhu ◽

Hong Lu ◽

Meiling Zhong ◽

...

Keyword(s):

Risk Factors ◽

Cervical Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Locally Advanced ◽

Lymph Node Status ◽

Advanced Cervical Cancer ◽

Retroperitoneal Lymph Node ◽

Node Metastasis ◽

Metastasis Rate

Abstract Background The assessment of retroperitoneal lymph node status in patients with locally advanced cervical cancer is still a problem. This study aimed to explore the choice of these assessment methods. Methods Laparoscopic retroperitoneal lymphadenectomy was performed in 96 patients with advanced cervical cancer. The positive rates of lymph node metastasis were analyzed. The values of computed tomography lymph node minimum axial diameter (MAD) and squamous cell carcinoma antigen (SCC-Ag), and their combination in predicting retroperitoneal lymph node metastasis were compared. High-risk factors for common iliac lymph node (CILN) and/or para-aortic lymph node (PALN) metastasis were analyzed. Results The lymph node metastasis rate was 62.50% and the CILN and/or PALN metastasis rate was 31.25%. Overall, 96 patients had 172 visible lymph nodes. The positive rate of lymph node metastasis was significantly higher in the MAD ≥1.0 cm group (83.33%) than in the 0.5 cm ≤ MAD < 1.0 cm group (26.82%). The critical values of MAD and SCC-Ag in determining lymph node metastasis were 1.0 cm and 5.2 ng/mL, respectively. The accuracy, specificity, and Youden index of MAD ≥1.0 cm combined with SCC-Ag ≥ 5.2 ng/mL for evaluating lymph node metastasis were 75.71%, 100%, and 0.59, respectively, and were significantly different from the values for the MAD ≥1.0 cm (72.09%, 80.56%, and 0.47, respectively) and SCC-Ag ≥ 5.2 ng/mL (71.43%, 68.97%, and 0.42, respectively) groups. Correlation analysis showed that non-squamous cell carcinoma, pelvic lymph node (PLN) MAD ≥1.0 cm plus number ≥ 2, and 1 PLN MAD ≥1.0 cm with CILN and/or PALN MAD 0.5–1.0 cm were risk factors for CILN and/or PALN metastasis. Conclusion Patients with MAD ≥1.0 cm and SCC-Ag ≥ 5.2 ng/mL, as well as high risk factors for CILN and/or PALN metastasis, should undergo resection of enlarged lymph nodes below the common iliac gland and lymphadenectomy of CILN/PALN to reduce tumor burden and to clarify lymph node metastasis status for accurate guidance in follow-up treatment. Patients with MAD < 1.0 cm and SCC-Ag < 5.2 ng/mL may be treated with chemoradiotherapy directly based on imaging, given the low lymph node metastasis rate.

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Utility of preoperative ferumoxtran-10 enhanced MRI to evaluate retroperitoneal lymph node metastasis in advanced cervical cancer: Results of ACRIN 6671/GOG 0233.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.15_suppl.5035 ◽

2011 ◽

Vol 29 (15_suppl) ◽

pp. 5035-5035

Author(s):

M. Atri ◽

Z. Zhang ◽

H. Marques ◽

J. Gorelick ◽

M. Harisinghani ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Advanced Cervical Cancer ◽

Retroperitoneal Lymph Node ◽

Node Metastasis ◽

Enhanced Mri

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ACCURACY OF 18 F-FDG PET/CT FOR THE DETECTION OF PARA-AORTIC LYMPH NODE METASTASIS IN PATIENTS WITH EARLY BULKY AND LOCALLY ADVANCED UTERINE CERVICAL CARCINOMA.FIRST NATIONAL EXPERIENCE: IGCS-0046 Cervical Cancer

International Journal of Gynecological Cancer ◽

10.1136/00009577-201505001-00012 ◽

2015 ◽

Vol 25 (Supp 1) ◽

pp. 16-16

Author(s):

Acuña D. Aravena ◽

R. Pruzzo ◽

N. Barrena ◽

H. Amaral ◽

P. Torres ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Fdg Pet ◽

Locally Advanced ◽

Node Metastasis ◽

Pet Ct ◽

Aortic Lymph Node ◽

Fdg Pet Ct ◽

National Experience

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The comparison of accuracy between PET and PET/CT for detecting lymph node metastasis in cervical cancer: Prospective surgicopathologic study

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.5587 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 5587-5587

Author(s):

J. Park ◽

S. Seo ◽

S. Kang ◽

S. Lim ◽

M. Lim ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Tumor Size ◽

Predictive Value ◽

Metastatic Lymph Node ◽

Metastatic Tumor ◽

Clinical Staging ◽

Node Metastasis ◽

Pet Ct

5587 Background: Previosly, we reported the accuracy of positron emission tomography with 2-[fluorine18] fluoro-2-deoxy-D- glucose (FDG-PET) for detecting metastatic lymph node (LN) in cervical cancer (Eur J Cancer 2005: 41; 2086–92). The aim of this prospective study was to evaluate the accuracy of PET/CT for detecting lymph node metastasis in cervical cancer and to compare the accuracy between PET and PET/CT. Methods: From May 2002 to Jul 2006, 86 patients with untreated stage IB-IVA cervical cancer were enrolled. All patients underwent pretreatment clinical staging including PET (May 2002-Aug 2003, 54 patients) or PET/CT (Jan 2004-Jul 2006, 32 patients) followed by surgical staging including systematic pelvic and paraaortic lymph node (PLN and PALN) dissection. To enable region specific comparisons, PALN and PLN were divided into eight regions: both PALN, both common iliac areas, both external iliac areas, and both internal iliac/obturator areas. Each lymph node was sliced at 2-mm intervals perpendicular to the greatest dimension to maximize the likelihood of detecting micrometastases. All metastatic tumor size in each involved lymph node was measured. Histopathologic evaluation of lymph nodes was the diagnostic standard. The study protocol was approved by Institutioal Review Board, and a written informed consent was obtained. Results: A total of 688 LN regions were evaluated. The sensitivity, specificity, positive predictive value, and negative predictive value of PET and PET/CT are shown in Table 1 . As the metastatic tumor size increased, the sensitivity of PET and PET/CT was improved. Although there were no differences in sensitivity for detecting large sized (> 5mm or 10mm) metastatic tumor, PET/CT was more sensitive than PET for all pathologically proven LN metastasis which included small sized (< 5mm) metastatic tumor. Conclusions: PET/CT was more sensitive than PET for detecting small sized (<5mm) lymph node metastasis in cervical cancer. [Table: see text] No significant financial relationships to disclose.

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