Predictive Value of FDG PET/CT to Detect Lymph Node Metastases in Cervical Cancer - PubMed (original) (raw)
Predictive Value of FDG PET/CT to Detect Lymph Node Metastases in Cervical Cancer
Laurie L Brunette et al. Clin Nucl Med. 2018 Nov.
Abstract
Purpose: The aim of this study was to determine the prognostic significance of PET/CT findings in women with cervical cancer and describe the normalization of lymph node SUVmax (nSUVmax).
Materials and methods: A retrospective review was performed of 113 patients with cervical cancer who underwent a PET/CT before receiving definitive therapy. SUVmax measurements were normalized to the SUV of the pelvic blood pool. Patient, tumor, and PET/CT data were correlated to extracervical recurrence-free survival (ecRFS) and lymph node pathology.
Results: Of 113 patients, there were 23 (20%) extracervical recurrences. On univariate analysis, stage, histology, nSUVmax, and radiographic size of the primary tumor, and nSUVmax of the most hypermetabolic lymph node were significantly associated with ecRFS. On multivariable analysis, nSUVmax and radiographic size of the primary tumor remained associated with ecRFS (both P < 0.001). Sixty-six patients underwent pelvic, common iliac, and/or para-aortic nodal sampling. The sensitivity, specificity, false-negative, and false-positive rates of PET/CT for lymph node metastases were 53%, 75%, 6%, and 82%, respectively. On univariate analysis, nSUVmax, and radiographic size of the primary tumor, and nSUVmax of the most hypermetabolic lymph node, and radiographic size of the largest lymph node, were associated with the presence of at least one pathologically positive lymph node. On multivariable analysis, only the radiographic size of the largest lymph node remained significantly associated with lymph node metastases (P < 0.001).
Conclusions: The size and nSUVmax of the primary tumor were associated with ecRFS. PET/CT has a low false-negative rate but high false-positive rate for lymph node metastases.
Figures
FIGURE 1.
PET/CT findings and treatment strategy for patient cohort.
FIGURE 2.
Comparison of the size and SUVmax of the most concerning lymph node on PET/CT with recurrence outcomes. For each radiographically positive lymph node on PET/CT, the size and SUVmax of the lymph node is plotted. All SUVmax values are normalized to the pelvic blood pool background SUV as a ratio (nSUVmax). All size measurements are the largest of the 3 dimensions measured for each lymph node, in centimeters. The decision to give extended field radiation (EF) may have been based on PET/CT characteristics or pathology data for the pelvic, common iliac, or para-aortic lymph node sites. A, Cervical cancer recurrence based on the size and normalized SUVmax of the most concerning lymph node on pretreatment PET/CT. B, Cervical cancer recurrence based on the size and normalized SUVmax of the most concerning common iliac or para-aortic lymph node on the pretreatment PET/CT and extension of the radiation therapy field.
FIGURE 3.
Pathologic positivity of lymph nodes compared with PET/CT measurements. For each radiographically positive lymph node on PET/CT, the size and SUVmax of the lymph node is plotted. All SUVmax values are normalized to the pelvic blood pool background SUV as a ratio (nSUVmax). All size measurements are the largest of the 3 dimensions measured for each lymph node, in centimeters. For each lymph node site sampled (right and left pelvic, common iliac, and para-aortic), the site was considered pathologically positive if at least 1 lymph node had metastatic disease. If all lymph nodes in that site were pathologically negative, the site was considered negative. For each plotted individual radiographically positive lymph node, the corresponding lymph node sites’ pathology is noted. A, Pathologic positivity of pelvic lymph nodes by PET/CT characteristics. B, Pathologic positivity of common iliac and para-aortic lymph nodes by PET/CT characteristics.
References
- SEER Cancer Stat Facts: Cervix Uteri Cancer. National Cancer Institute; Bethesda, MD: Available at: http://seer.cancer.gov/statfacts/html/cervix.html. Accessed March 04, 2017.
- Pecorelli S, Zigliani L, Odicino F. Revised FIGO staging for carcinoma of the cervix. Int J Gynaecol Obstet. 2009;105:107–108. -PubMed
- Quinn MA, Benedet JL, Odicino F, et al. Carcinoma of the cervix uteri. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet. 2006;95(Suppl 1):S43–S103. -PubMed
- Network. NCC. Cervical Cancer (Version 12018). https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf. Accessed June 18, 2018.
- Sironi S, Buda A, Picchio M, et al. Lymph node metastasis in patients with clinical early-stage cervical cancer: detection with integrated FDG PET/CT. Radiology. 2006;238:272–279. -PubMed
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