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Molnar O, Straciuc OM, Mihuțiu S, Lazăr L. Impact of PET/CT Imaging with FDG in Locally Advanced Cervical Carcinoma-A Literature Review. Curr Oncol 2024; 31:2508-2526. [PMID: 38785469 PMCID: PMC11119194 DOI: 10.3390/curroncol31050188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 04/27/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024] Open
Abstract
Positron emission tomography (PET) and computed tomography (CT) have evolved as a pivotal diagnostic modality in the field of oncology. With its increasing application in staging and ready availability, it becomes imperative for committed radiation oncologists to possess a complete analysis and understanding of integration of molecular imaging, which can be helpful for radiation planning, while also acknowledging its possible limitations and challenges. A significant obstacle lies in the synthesis and design of tumor-specific bmolecules for diagnosing and treating cancer. The utilization of radiation in medical biochemistry and biotechnology, encompassing diagnosis, therapy, and control of biological systems, is encapsulated under the umbrella term "nuclear medicine". Notably, the application of various radioisotopes in pharmaceutics has garnered significant attention, particularly in the realm of delivery systems for drugs, DNA, and imaging agents. The present article provides a comprehensive review of use of novel techniques PET and CT with major positron-emitting radiopharmaceuticals currently in progress or utilized in clinical practice with their integration into imaging and radiation therapy.
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Affiliation(s)
- Ottó Molnar
- Doctoral Studies Department, Biomedical Science, 410087 Oradea, Romania
| | - Oreste Mihai Straciuc
- Doctoral Studies Department, Biomedical Science, 410087 Oradea, Romania
- Centrul PET/CT Pozitron Diagnosztika, 410035 Oradea, Romania
| | - Simona Mihuțiu
- Department of Medicine-Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, 410073 Oradea, Romania
- Oncology Department, Pelican Hospital, 410469 Oradea, Romania
| | - Liviu Lazăr
- Doctoral Studies Department, Biomedical Science, 410087 Oradea, Romania
- Department of Medicine-Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, 410073 Oradea, Romania
- Băile Felix Medical Rehabilitation Hospital, 417500 Băile Felix, Romania
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Allahqoli L, Hakimi S, Laganà AS, Momenimovahed Z, Mazidimoradi A, Rahmani A, Fallahi A, Salehiniya H, Ghiasvand MM, Alkatout I. 18F-FDG PET/MRI and 18F-FDG PET/CT for the Management of Gynecological Malignancies: A Comprehensive Review of the Literature. J Imaging 2023; 9:223. [PMID: 37888330 PMCID: PMC10607780 DOI: 10.3390/jimaging9100223] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVE Positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro- D-glucose integrated with computed tomography (18F-FDG PET/CT) or magnetic resonance imaging (18F-FDG PET/MRI) has emerged as a promising tool for managing various types of cancer. This review study was conducted to investigate the role of 18F- FDG PET/CT and FDG PET/MRI in the management of gynecological malignancies. SEARCH STRATEGY We searched for relevant articles in the three databases PubMed/MEDLINE, Scopus, and Web of Science. SELECTION CRITERIA All studies reporting data on the FDG PET/CT and FDG PET MRI in the management of gynecological cancer, performed anywhere in the world and published exclusively in the English language, were included in the present study. DATA COLLECTION AND ANALYSIS We used the EndNote software (EndNote X8.1, Thomson Reuters) to list the studies and screen them on the basis of the inclusion criteria. Data, including first author, publication year, sample size, clinical application, imaging type, and main result, were extracted and tabulated in Excel. The sensitivity, specificity, and diagnostic accuracy of the modalities were extracted and summarized. MAIN RESULTS After screening 988 records, 166 studies published between 2004 and 2022 were included, covering various methodologies. Studies were divided into the following five categories: the role of FDG PET/CT and FDG-PET/MRI in the management of: (a) endometrial cancer (n = 30); (b) ovarian cancer (n = 60); (c) cervical cancer (n = 50); (d) vulvar and vagina cancers (n = 12); and (e) gynecological cancers (n = 14). CONCLUSIONS FDG PET/CT and FDG PET/MRI have demonstrated potential as non-invasive imaging tools for enhancing the management of gynecological malignancies. Nevertheless, certain associated challenges warrant attention.
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Affiliation(s)
- Leila Allahqoli
- Ministry of Health and Medical Education, Tehran 1467664961, Iran
| | - Sevil Hakimi
- Faculty of Nursing and Midwifery, Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz 516615731, Iran;
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Zohre Momenimovahed
- Department of Midwifery and Reproductive Health, Qom University of Medical Sciences, Qom 3716993456, Iran;
| | - Afrooz Mazidimoradi
- Neyriz Public Health Clinic, Shiraz University of Medical Sciences, Shiraz 7134845794, Iran;
| | - Azam Rahmani
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran 141973317, Iran;
| | - Arezoo Fallahi
- Department of Public Health, Faculty of Health, Kurdistan University of Medical Sciences, Sanandaj 6617713446, Iran;
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand 9717853076, Iran;
| | - Mohammad Matin Ghiasvand
- Department of Computer Engineering, Amirkabir University of Technology (AUT), Tehran 1591634311, Iran;
| | - Ibrahim Alkatout
- University Hospitals Schleswig-Holstein, Campus Kiel, Kiel School of Gynaecological Endoscopy, Arnold-Heller-Str. 3, Haus 24, 24105 Kiel, Germany;
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Zhu M, Zhuo Q, Liu W, Guan C, Zuo Y. Imaging evaluation of para-aortic lymph nodes in cervical cancer. Acta Radiol 2023; 64:2611-2617. [PMID: 37321631 DOI: 10.1177/02841851231179178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND In recent years, much literature has reported the diagnostic value of computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)-CT in para-aortic lymph node metastasis of cervical cancer. PURPOSE To compare and analyze the para-aortic lymph node presentations found in cervical cancer on different images in order to determine the best precise imaging method for identifying metastatic lymph nodes. MATERIAL AND METHODS PubMed, Web of Science, MEDLINE, and other databases were searched for the non-invasive detection of metastatic lymph nodes for a comprehensive comparison. RESULTS Positive lymph nodes on CT are significantly related to the following factors: short axis ≥10 mm; and round or central necrosis. Positive lymph nodes on MRI are significantly related to the following factors: short axis ≥8 mm; inhomogeneous signal intensity; morphology: round, irregular edge, extracapsular invasion, central necrosis, loss of lymph node structure, burrs, or lobes; and ADC value decreases, combined with local actuality. On PET-CT examination, when the short axis of the lymph node is >5 mm, the SUV is >2.5, or the FDG uptake is greater than that of the surrounding tissue, it is a metastatic lymph node. CONCLUSION In conclusion, different imaging techniques show metastatic lymph nodes in different ways. Combining the patient's medical history with the symptoms of the aforementioned lymph nodes, together with one or more imaging techniques, is important to diagnose para-aortic lymph nodes in cervical cancer.
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Affiliation(s)
- Minying Zhu
- Department of Gynecological Oncology, Cancer Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, PR China
| | - Qingchan Zhuo
- Department of Gynecological Oncology, Cancer Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, PR China
| | - Wenci Liu
- Department of Radiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, PR China
| | - Chengnong Guan
- Department Cancer Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, PR China
| | - Yufang Zuo
- Department of Gynecological Oncology, Cancer Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, PR China
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Holm J, Gerke O, Vilstrup MH, Spasojevic D, Sponholtz SE, Jochumsen KM, Thomassen A, Hildebrandt MG, Jensen PT. Improved stratification of stage-specific survival for cervical uterine cancer by integrating FDG-PET/CT and MRI for lymph node staging in 2018 FIGO classification. Gynecol Oncol 2022; 167:152-158. [PMID: 36182533 DOI: 10.1016/j.ygyno.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Staging carcinoma of the uterine cervix (CCU) by FIGO-2018 suggests stage migration of FIGO-2009 stage I-III patients with lymph node metastasis into FIGO-2018 stage IIIC. We aimed to investigate the prognostic value of lymph node metastases identified by imaging. METHODS We enrolled all patients with biopsy-verified CCU from 2007 to 2016 at Odense University Hospital, Denmark. FDG-PET/CT and MRI were performed before clinical examination in general anesthesia. Disease-specific mortality was compared between women with lymph node-positive and lymph node-negative imaging. RESULTS In total, 488 patients underwent clinical staging according to FIGO-2009. Lymph node-positive imaging was identified in 146 (30%) patients: 0/36 (0%) in stage IA, 22/195 (11%) in IBI, 14/30 (47%) in IB2, 70/164 (43%) in II and 40/63 (63%) in III. The 5-year cumulative incidence of death due to CCU lymph node-negative vs. lymph node-positive patients was 0.8% vs. 7.1% (p = 0.034) in stage IBI, 0% vs. 34.5% (p = 0.003) in stage IB2, 15.1% vs. 41.4% (p < 0.0001) in stage II, and 33.3% vs. 46.6% (p = 0.28) in stage III by FIGO-2009. CONCLUSIONS One of three women with FIGO-2009 stage I-III CCU had suspected lymph node metastasis on imaging and is upstaged to stage IIIC according to FIGO-2018. The cancer-specific mortality by CCU was significantly lower in the lymph node-negative women stages IBI-II, thus supporting stage migration due to suspected lymph node metastasis. However, the exact prognostic value within stage IIIC is challenged, and future revision of FIGO stages may include new sub-stages.
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Affiliation(s)
- Jorun Holm
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Denmark.
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Denmark
| | - Mie Holm Vilstrup
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Diana Spasojevic
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | | | | | - Anders Thomassen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Malene Grubbe Hildebrandt
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Denmark
| | - Pernille Tine Jensen
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Denmark; Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Denmark
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Upstaging by para-aortic lymph node dissection in patients with locally advanced cervical cancer: A systematic review and meta-analysis. Gynecol Oncol 2021; 164:667-674. [PMID: 34969533 DOI: 10.1016/j.ygyno.2021.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Accurate staging of para-aortic nodal status in cervical cancer is of great importance for individualizing treatment and impacting outcomes. Three-dimensional imaging (i.e. PET, CT, MRI) may miss para-aortic lymph node (PALN) metastases. The aim of this study was to systematically review and meta-analyze the proportion of upstaging by PALN dissection in patients with locally advanced cervical cancer without suspicious PALNs on imaging. METHODS PubMed/MEDLINE and Embase were systematically searched. The analysis included diagnostic studies that reported on 3D imaging and pre-therapeutic surgical assessment of PALN status in patients with cervical cancer. An overall pooled upstaging rate was calculated using a random-effects model. RESULTS The search identified 16 eligible studies including 18 cohorts with a total of 1530 patients. Pooling of 12 cohorts demonstrated an upstaging rate of 12% (95% confidence interval [CI] 10-15%) by PALN dissection after negative PET or PET-CT. Pooling of 6 cohorts demonstrated a pooled upstaging rate of 11% (95% CI: 8-16%) by PALN dissection after negative MRI or CT. No significant heterogeneity in upstaging proportions across cohorts was observed (I2 = 0% and 27%, respectively). In 7 cohorts including only patients with pelvic nodal metastases on imaging (but no suspicion of PALN involvement) a pooled upstaging rate by PALN dissection of 21% (95% CI: 17-26%) was found (I2 = 0%). CONCLUSIONS This meta-analysis demonstrates that in case of no suspicious PALN on PET-CT or MRI, PALN dissection still identifies lymph node metastases in a considerable amount of patients with locally advanced cervical cancer and especially in those patients with confirmed pelvic nodal metastases.
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Paraaortic Lymph Nodal Staging & Evaluation of Treatment Outcome by 18–Fluorodeoxyglucose PET (Positron Emission Tomography) in Advanced Cervical Cancer: Final Results of a Prospective Observational Cohort Study. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00565-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wahl RL, Hicks RJ. PET Diagnosis and Response Monitoring in Oncology. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Adam JA, van Diepen PR, Mom CH, Stoker J, van Eck-Smit BLF, Bipat S. [ 18F]FDG-PET or PET/CT in the evaluation of pelvic and para-aortic lymph nodes in patients with locally advanced cervical cancer: A systematic review of the literature. Gynecol Oncol 2020; 159:588-596. [PMID: 32921477 DOI: 10.1016/j.ygyno.2020.08.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/17/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE Imaging is essential in detecting lymph node metastases for radiotherapy treatment planning in locally advanced cervical cancer (LACC). There are not many data on the performance of [18F]FDG-PET(CT) in showing lymph node metastases in LACC. We pooled sensitivity and specificity of [18F]FDG-PET(CT) for detecting pelvic and/or para-aortic lymph node metastases in patients with LACC. Also, the positive and negative posttest probabilities at high and low levels of prevalence were determined. METHODS MEDLINE and EMBASE searches were performed and quality characteristics assessed. Logit-sensitivity and logit-specificity estimates with corresponding standard errors were calculated. Summary estimates of sensitivity and specificity with corresponding 95% confidence intervals (CIs) were calculated by anti-logit transformation. Positive and negative likelihood ratios (LRs) were calculated from the mean logit-sensitivity and mean logit-specificity and the corresponding standard errors. The posttest probabilities were determined by Bayesian approach. RESULTS Twelve studies were included with a total of 778 patients aged 10-85 years. For pelvic nodes, summary estimates of sensitivity, specificity, LR+ and LR- were: 0.88 (95%CI: 0.40-0.99), 0.93 (95%CI: 0.85-0.97), 11.90 (95%CI: 5.32-26.62) and 0.13 (95%CI: 0.01-1.08). At the lowest prevalence of 0.15 the positive predictive value (PPV) and negative predictive value (NPV) were 0.68 and 0.98, at the highest prevalence of 0.65, 0.96 and 0.81. For the para-aortic nodes, the summary estimates of sensitivity, specificity LR+ and LR- were: 0.40 (95%CI: 0.18-0.66), 0.93 (95%CI: 0.91-0.95), 6.08 (95%CI: 2.90-12.78) and 0.64 (95%CI: 0.42-0.99), respectively. At the lowest prevalence of 0.17 the PPV and NPV were 0.55 and 0.88, at the highest prevalence of 0.50, 0.86 and 0.61. CONCLUSION The PPV and NPV of [18F]FDG-PET(CT) showing lymph node metastases in patients with LACC improves with higher prevalence. Prevalence and predictive values should be taken into account when determining therapeutic strategies based on [18F]FDG-PET(CT).
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Affiliation(s)
- Judit A Adam
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | - Pascal R van Diepen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - Constantijne H Mom
- Department of Gynecologic Oncology, Amsterdam UMC, Free University Amsterdam, De Boelelaan 1117, 1081, HV, Amsterdam, the Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - Berthe L F van Eck-Smit
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - Shandra Bipat
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
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Varela Cagetti L, Zemmour C, Minsat M, Lambaudie E, Houvenaeghel G, Provansal M, Cappiello MA, Rua S, Jauffret C, Ferré M, Mailleux H, Gonzague L, Tallet A. Lessons from radiochemotherapy and modern image-guided adaptive brachytherapy followed by hysterectomy. Gynecol Oncol 2019; 156:328-334. [PMID: 31864683 DOI: 10.1016/j.ygyno.2019.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/28/2019] [Accepted: 12/01/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To analyze the clinical outcomes and the safety of radiochemotherapy (RCT) and image-guided adaptive brachytherapy (IGABT) and to evaluate the impact of hysterectomy (HT) as completion of treatment for cervical cancer. METHODS AND MATERIALS 145 patients with locally advanced cervical cancer were treated at our institution. Patients underwent RCT and IGABT, then hysterectomy (HT) as completion of treatment was performed, with the exception of patients with surgical contraindications, para aortic metastatic disease or patients who refused surgery. Clinical outcomes and morbidity were retrospectively reviewed in both groups. Local relapse free survival (LRFS), pelvic relapse free survival (PRFS) and overall survival (OS) were analyzed. RESULTS Completion HT was performed in 90 (62.1%) patients. Complete histological response and microscopic disease were found in 77 patients (85.6%). Local relapse was observed in 14 patients (9.6%) without differences between completion HT group and the definitive RCT and IGABT group (Odds Ratio OR = 1.73 [0.57-5.23], p = 0.33). The estimated 3-year LRFS and PRFS for the entire population were respectively 90% [84%-94%] and 93% [87%-96%], with no significant differences between them (respectively Hazard Ratio HR = 0.57 [0.20-1.64], p = 0.30 and HR = 0.37 [0.10-1.31], p = 0.12). The estimated 3-year OS rate for the whole population was 84% [75%-91%] with no significant differences between groups (HR = 0.81 [0.32-2.06], p = 0.65). Regarding morbidity, grade ≥ 2 vaginal toxicity was more frequent in the definitive RCT and IGABT group (43.6% vs 26.7%, p = 0.04). All grade 4 toxicity events were reported in the completion HT group. CONCLUSIONS Due to high severe toxicity, RCT and IGABT with dose escalation followed by completion hysterectomy don't seem compatible. No benefit and increased severe late morbidity were observed. Combined intracavitary/interstitial technique is mandatory in large target volume at brachytherapy.
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Affiliation(s)
| | - Christophe Zemmour
- Department of Clinical Research and Investigation, Biostatistics and Methodology Unit, Institut Paoli-Calmettes, Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France
| | - Mathieu Minsat
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Eric Lambaudie
- Department of Surgical Oncology, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, CRCM, 13000 Marseille, France
| | - Gilles Houvenaeghel
- Department of Surgical Oncology, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, CRCM, 13000 Marseille, France; Aix-Marseille University, Inserm, CNRS, Institut Paoli Calmettes, CRCM, Marseille, France; Institut Paoli Calmettes, Oncology Surgery 2, 232 Boulevard Sainte Marguerite, Marseille, France
| | - Magalie Provansal
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | | | - Sandrine Rua
- Institut Paoli Calmettes, Oncology Surgery 2, 232 Boulevard Sainte Marguerite, Marseille, France
| | - Camille Jauffret
- Institut Paoli Calmettes, Oncology Surgery 2, 232 Boulevard Sainte Marguerite, Marseille, France
| | - Marjorie Ferré
- Department of Medical Physics, Institut Paoli-Calmettes, Marseille, France
| | - Hugues Mailleux
- Department of Medical Physics, Institut Paoli-Calmettes, Marseille, France
| | - Laurence Gonzague
- Department of Radiation Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Agnès Tallet
- Department of Radiation Oncology, Institut Paoli-Calmettes, Marseille, France
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The diagnostic performance of PET/CT scans for the detection of para-aortic metastatic lymph nodes in patients with cervical cancer: A meta-analysis. PLoS One 2019; 14:e0220080. [PMID: 31318962 PMCID: PMC6638976 DOI: 10.1371/journal.pone.0220080] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/07/2019] [Indexed: 12/18/2022] Open
Abstract
Objective We performed a meta-analysis to evaluate the diagnostic value of positron emission tomography/computed tomography (PET/CT) in the detection of para-aortic lymph node metastasis in cervical cancer. Methods We searched the PubMed, Embase, Web of Science, Cochrane Library, Chinese Biological Medicine (CBM), Chinese National Knowledge Infrastructure (CNKI), Wanfang and VIP databases in all languages from their inception to September 2018. Stat15.0 software was used to obtain pooled estimates of sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) as well as a summary receiver operating characteristic (SROC) curves. Deek‘s funnel plot was used to assess publication bias. QUADAS-2 was used to evaluate the quality of the studies. The protocol for this meta-analysis is registered in PROSPERO (CRD42019115330). Results We obtained 14 studies, and the pooled estimates for sensitivity and specificity of PET/CT were 0.71 (95% confidence interval (CI) = 0.54–0.83) and 0.97 (95% CI = 0.93–0.98), respectively. Pooled PLR and NLR were 21.53 and 0.30, respectively. The diagnostic odds ratio (DOR) was70.59, and the area under the curve (AUC) was 0.95. Conclusion PET/CT is an effective and important imaging method for the diagnosis of para-aortic lymph node metastasis in early cervical cancer.
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Fiorentino A, Laudicella R, Ciurlia E, Annunziata S, Lancellotta V, Mapelli P, Tuscano C, Caobelli F, Evangelista L, Marino L, Quartuccio N, Fiore M, Borghetti P, Chiaravalloti A, Ricci M, Desideri I, Alongi P. Positron emission tomography with computed tomography imaging (PET/CT) for the radiotherapy planning definition of the biological target volume: PART 2. Crit Rev Oncol Hematol 2019; 139:117-124. [PMID: 30940428 DOI: 10.1016/j.critrevonc.2019.03.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/14/2019] [Accepted: 03/14/2019] [Indexed: 02/07/2023] Open
Abstract
AIM Positron Emission Tomography with Computed Tomography (PET/CT) has been proven to be useful in the definition of Radiotherapy (RT) target volume. In this regard, the present expert review summarizes existing data for pancreas, prostate, gynecological and rectum/anal cancer. METHODS A comprehensive search of published original article was made, based on SCOPUS and PubMed database, selecting the paper that evaluated the role of PET/CT in the definition of RT volume. RESULTS FDG-PET has an important and promising role for pancreatic cancer. Choline PET/CT could be useful for identifying high-risk volumes for prostate cancer; while PSMA PET/CT is still under evaluation. FDG PET/CT in gynecological cancers has been shown to impact external-beam RT planning. The role of FDG-PET for Gross Tumor volume identification is crucial, representing a useful and powerful tool for anal and rectal cancer. CONCLUSION Taken together, molecular and functional imaging approaches offer a major step to individualize radiotherapeutic approach.
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Affiliation(s)
- Alba Fiorentino
- Radiotherapy Oncology Department, General Regional Hospital "F. Miulli", Acquaviva delle Fonti-Bari, Italy.
| | - Riccardo Laudicella
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, Italy
| | - Elisa Ciurlia
- Radiotherapy Oncology Department, Vito Fazzi Hospital, Lecce, Italy
| | - Salvatore Annunziata
- Fondazione Policlinico A. Gemelli IRCCS-Università Cattolica Sacro Cuore, Roma, Italy
| | - Valentina Lancellotta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Roma, Italy
| | - Paola Mapelli
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carmelo Tuscano
- Radiotherapy Oncology Department, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Federico Caobelli
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Laura Evangelista
- Nuclear Medicine Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Lorenza Marino
- Radiotherapy Oncology Department, REM, Viagrande, Catania, Italy
| | | | - Michele Fiore
- Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Paolo Borghetti
- Radiation Oncology Department University and Spedali Civili, Brescia, Italy
| | - Agostino Chiaravalloti
- IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy; Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | - Maria Ricci
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Isacco Desideri
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Italy
| | - Pierpaolo Alongi
- Department of Radiological Sciences, Nuclear Medicine Service, Fondazione Istituto G. Giglio, Cefalu, Italy
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The analysis of the long-term outcomes in elderly women treated for locally advanced cervical cancer. J Contemp Brachytherapy 2018; 10:411-417. [PMID: 30479617 PMCID: PMC6251449 DOI: 10.5114/jcb.2018.79334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 10/05/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose Locally advanced cervical cancer (LACC) should be treated with a combination of external irradiation and brachytherapy with concurrent chemotherapy. However, as cervical carcinoma cells can disperse by way of the lymphatic system to either pelvic or para-aortic nodes, planning the extent of radiation requires precise information about the spread of the disease to the lymph nodes, especially to the para-aortic area. Material and methods All of the 75 women included in our study underwent chemoradiotherapy, which started with brachytherapy. Out of them, 54 have undergone radical hysterectomy with lymphadenectomy followed by chemoradiation. We have retrospectively analyzed the 5-year overall survival (OS) rates relative to the lymph node involvement, the type of lymphadenectomy performed (pelvic, para-aortic, or both), the size of the tumor (> or < 4 cm), the histological type, grading, and the age of patients. Results We observed significant differences in the OS rates relative to the age of the patients with LACC. We noted significant differences in the OS rates related to para-aortic lymphadenectomy and presence of lymph node metastases. Conclusions Para-aortic lymphadenectomy seems to have a positive influence on long-term outcomes in the LACC patients, and elderly patients may benefit more from applied therapy.
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Ruan J, Zhang Y, Ren H. Meta-analysis of PET/CT Detect Lymph Nodes Metastases of Cervical Cancer. Open Med (Wars) 2018; 13:436-442. [PMID: 30263970 PMCID: PMC6153451 DOI: 10.1515/med-2018-0065] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/14/2018] [Indexed: 12/03/2022] Open
Abstract
Objective The aim of this study was to assess the diagnostic value of PET/CT for metastatic lymph nodes in cervical cancer patients. Methods Searching in the databases including PubMed, Embase, Web of Science, Cochrane Library and Google Scholar about non-invasive modalities for detecting lymph nodes metastases during 2000~2017. Following further screening, the extracted effective data were calculated by Meta-Disc 1.4 software, such as sensitivity (SEN), specificity (SPE), positive likelihood (LR+), and negative likelihood ratio (LR-). Results we obtained 27 articles. The pooled estimates for sensitivity of PET/CT were 0.72 (95% CI, [0.69, 0.75]); for specificity were 0.96 (95% CI, [0.96, 0.97]). Its weighted AUC was 0.93. Conclusion PET/CT remains to be an effective method for diagnosis of metastatic lymph nodes from cervical cancer.
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Affiliation(s)
- Jianjiang Ruan
- Department of Radiology, Shaoxing Shangyu Women and Children Hospital, Zhejiang 312300, China
| | - Yueqiao Zhang
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Hong Ren
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
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Evaluating the Role of F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Scanning in the Staging of Patients With Stage IIIB Cervical Carcinoma and the Impact on Treatment Decisions. Int J Gynecol Cancer 2018; 28:379-384. [DOI: 10.1097/igc.0000000000001174] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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15
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Management of Para-aortic Lymph Node Disease in Patients With Cervical Cancer: What Is the Best Approach? Int J Gynecol Cancer 2018; 27:543-549. [PMID: 28107261 DOI: 10.1097/igc.0000000000000914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Cervical cancer remains a prevalent and deadly disease in low-income countries, especially among young and otherwise healthy women. Multimodality treatment has led to a significant improvement in outcomes for patients with locally advanced disease, and this is mainly because of the incorporation of platinum-based chemoradiotherapy in current treatment protocols. However, locally advanced tumors are associated with a greater risk for para-aortic lymph node (PALN) involvement, which is an important adverse prognostic factor. Most staging techniques have low accuracy for detection of disease in this area, which could lead to understaging and undertreatment. Meanwhile, patients with PALN disease are underrepresented in trials addressing the treatment of advanced cervical cancer and a few studies have been directed at this population. The aim of this review is to analyze the current data regarding staging and treatment of cervical cancer with PALN disease to determine which strategy is best when managing these patients.
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Guler OC, Torun N, Yildirim BA, Onal C. Pretreatment metabolic tumour volume and total lesion glycolysis are not independent prognosticators for locally advanced cervical cancer patients treated with chemoradiotherapy. Br J Radiol 2018; 91:20170552. [PMID: 29293366 DOI: 10.1259/bjr.20170552] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the prognostic significance of metabolic parameters derived from fludeoxyglucose (FDG) positron emission tomography (PET)/CT, in cervical cancer patients treated with concurrent chemoradiotherapy. METHODS We retrospectively reviewed medical records from 129 biopsy-proven non-metastatic cervical cancer patients treated with external radiotherapy and intracavitary brachytherapy at our department. Correlation between metabolic parameters and tumour characteristics was evaluated. Prognostic factors for survival, local control and distant metastasis were analysed. RESULTS The median follow up for all patients and surviving patients was 30.0 months (range, 3.7-94.7 months) and 50.5 months (range, 14.5-94.7 months), respectively. The 2- and 5-year overall survival (OS) and disease-free survival (DFS) rates were 68 42, 54 and 38%, respectively. The maximum standardized uptake value (SUVmax), SUVmean, metabolic tumour volume (MTV) and total lesion glycolysis were significantly higher in patients with larger tumours (>4 cm) and partial regression or progressive disease after definitive treatment compared to patients with smaller tumour (≤4 cm) and post-treatment complete response. On univariate analysis, stage, lymph node metastasis, tumour size >4 cm, SUVmax, MTV, SUVmean and total lesion glycolysis were prognostic factors for OS and DFS. On multivariate analysis, only larger tumour and presence of lymph node metastasis were significant prognostic factors for both OS and DFS. Additionally, extensive stage was a significant prognosticator for DFS. CONCLUSION Although, metabolic parameters derived from FDG-PET/CT had a prognostic significance in univariate analysis, the significance was lost in multivariate analysis where tumour stage, size and lymph node status were the only independent parameters. Advances in knowledge: The clinical benefit of using FDG-PET/CT metabolic parameters to evaluate the high-risk patients among cervical cancer patients and to eventually change patient management still needs further clarification.
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Affiliation(s)
- Ozan Cem Guler
- 1 Department of Radiation Oncology, Karadeniz Technical University Faculty of Medicine , Trabzon , Turkey
| | - Nese Torun
- 2 Department of Nuclear Medicine, Baskent University Faculty of Medicine , Adana , Turkey
| | - Berna Akkus Yildirim
- 3 Department of Radiation Oncology, Baskent University Faculty of Medicine , Adana , Turkey
| | - Cem Onal
- 3 Department of Radiation Oncology, Baskent University Faculty of Medicine , Adana , Turkey
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Tax C, Abbink K, Rovers MM, Bekkers RLM, Zusterzeel PLM. Para-aortic lymphadenectomy in advanced stage cervical cancer, a protocol for comparing safety, feasibility and diagnostic accuracy of surgical staging versus PET-CT; PALDISC trial. Pilot Feasibility Stud 2018; 4:27. [PMID: 29318031 PMCID: PMC5755440 DOI: 10.1186/s40814-017-0218-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 12/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently, a PET-CT is used to assess the need for extended field radiotherapy of para-aortic lymph nodes (PALN) in International Federation of Gynaecology and Obstetrics (FIGO) stage IB2, IIA2-IVA (locally advanced stage) cervical cancer. A small study established a sensitivity and specificity estimate for PALN metastases of 50% (95% CI; 7-93%) and 83% (95% CI; 52-98%), respectively. Surgical staging of PALN may lead to a higher diagnostic accuracy. However, surgical staging of para-aortic lymph nodes in locally advanced stage cervical cancer is not common practice. Therefore, a phase 2 randomised controlled trial is needed to assess its safety and feasibility. METHODS/DESIGN In addition to standard imaging (MRI or CT scan) with PET-CT, 30 adult women with FIGO stage IB2, IIA2-IVA cervical cancer will be randomised to receive either surgical staging or usual PET-CT staging. Administering extended field radiotherapy will be based on lymphadenectomy results for the intervention group and on the PET-CT results for the control group. Follow-up visits at 0, 3, 6, 9 and 12 months will assess health-related quality of life and progression-free survival.Primary safety and feasibility outcomes of surgical staging will be assessed by calculating means with 95% confidence intervals for duration of surgery, number of complications, blood loss, nodal yield after para-aortic lymphadenectomy and treatment delay due to surgical staging. Secondary patient-centred outcomes on quality of life and first year survival will be documented and compared between the two groups. Estimates of sensitivity, specificity and negative and positive predictive values of MRI, PET-CT and surgical staging will be presented with 95% CI.. All analysis will be performed according to the intention to treat principle. DISCUSSION This study will assess safety and feasibility, expressed as the number and severity of complications, effect on quality of life and the treatment delay due to surgically staging para-aortic lymph nodes in locally advanced cervical cancer. It will provide insight in the diagnostic accuracy of the PET-CT and detection rate of missed (micro)metastases due to surgical staging. This information will be used to assess the necessity for a phase 3 study on the diagnostic accuracy of the PET-CT and surgical staging. If a phase 3 study is deemed necessary, current data can be used for sample size calculation of such a phase 3 study. TRIAL REGISTRATION Nederlands Trial Register/Dutch Trial Registry (www.trialregister.nl), NTR4922. Registered on 24 November 2014.
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Affiliation(s)
- Casper Tax
- Department of Operating Rooms 715, Radboud University Medical Centre, Radboudumc Institute for Health Sciences, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Karin Abbink
- Department of Gynaecology, Radboud University Medical Centre, Radboudumc Institute for Health Sciences, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Maroeska M. Rovers
- Department of Operating Rooms 715, Radboud University Medical Centre, Radboudumc Institute for Health Sciences, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
- Department of Health Evidence, Radboud University Medical Centre, Radboudumc Institute for Health Sciences, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Ruud L. M. Bekkers
- Department of Gynaecology, Radboud University Medical Centre, Radboudumc Institute for Health Sciences, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Petra L. M. Zusterzeel
- Department of Gynaecology, Radboud University Medical Centre, Radboudumc Institute for Health Sciences, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
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Jung W, Park KR, Lee KJ, Kim K, Lee J, Jeong S, Kim YJ, Kim J, Yoon HJ, Kang BC, Koo HS, Sung SH, Cho MS, Park S. Value of imaging study in predicting pelvic lymph node metastases of uterine cervical cancer. Radiat Oncol J 2017; 35:340-348. [PMID: 29232805 PMCID: PMC5769886 DOI: 10.3857/roj.2017.00206] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/25/2017] [Accepted: 08/14/2017] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To evaluate the diagnostic accuracy of computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT) in predicting pelvic lymph node (LN) metastases in patients with cervical cancer. MATERIALS AND METHODS From January 2009 to March 2015, 114 patients with FIGO stage IA1-IIB uterine cervical cancer who underwent hysterectomy with pelvic lymphadenectomy and took CT, MRI, and PET/CT before surgery were enrolled in this study. The criteria for LN metastases were a LN diameter ≥1.0 cm and/or the presence of central necrosis on CT, a LN diameter ≥1.0 cm on MRI, and a focally increased FDG uptake on PET/CT. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for pelvic LN metastases were estimated. RESULTS The sensitivity, specificity, PPV, NPV, and accuracy for detection of pelvic LN metastases were 51.4%, 85.9%, 41.3%, 90.1%, and 80.3% for CT; 24.3%, 96.3%, 56.3%, 86.8%, and 84.6% for MRI; and 48.6%, 89.5%, 47.4%, 90.0%, and 82.9% for PET/CT, respectively. The sensitivity of PET/CT and CT was higher than that of MRI (p=0.004 and p= 0.013, respectively). The specificity of MRI was higher than those of PET/CT and CT (p=0.002 and p=0.001, respectively). The difference of specificity between PET/CT and CT was not statistically significant (p=0.167). CONCLUSION These results indicate that preoperative CT, MRI, and PET/CT showed low to moderate sensitivity and PPV, and moderate to high specificity, NPV, and accuracy. More efforts are necessary to improve sensitivity of imaging modalities in order to predict pelvic LN metastases.
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Affiliation(s)
- Wonguen Jung
- Department of Radiation Oncology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kyung Ran Park
- Department of Radiation Oncology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kyung-Ja Lee
- Department of Radiation Oncology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jihae Lee
- Department of Radiation Oncology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Songmi Jeong
- Department of Radiation Oncology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Yi-Jun Kim
- Department of Radiation Oncology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jiyoung Kim
- Department of Radiation Oncology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Hai-Jeon Yoon
- Department of Nuclear Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Byung-Chul Kang
- Department of Radiology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Hae Soo Koo
- Department of Pathology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Sun Hee Sung
- Department of Pathology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Min-Sun Cho
- Department of Pathology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Sanghui Park
- Department of Pathology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
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Wetter A, Grueneisen J, Umutlu L. PET/MR imaging of pelvic malignancies. Eur J Radiol 2017; 94:A44-A51. [DOI: 10.1016/j.ejrad.2017.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 01/03/2023]
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Prognostic importance of lymph node-to-primary tumor standardized uptake value ratio in invasive squamous cell carcinoma of uterine cervix. Eur J Nucl Med Mol Imaging 2017; 44:1862-1869. [DOI: 10.1007/s00259-017-3729-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/10/2017] [Indexed: 10/19/2022]
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21
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Positron Emission Tomography/Computed Tomography for Gynecologic Malignancies. Obstet Gynecol Surv 2016; 71:545-56. [DOI: 10.1097/ogx.0000000000000345] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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22
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Atri M, Zhang Z, Dehdashti F, Lee SI, Ali S, Marques H, Koh WJ, Moore K, Landrum L, Kim JW, DiSilvestro P, Eisenhauer E, Schnell F, Gold M. Utility of PET-CT to evaluate retroperitoneal lymph node metastasis in advanced cervical cancer: Results of ACRIN6671/GOG0233 trial. Gynecol Oncol 2016; 142:413-9. [PMID: 27178725 DOI: 10.1016/j.ygyno.2016.05.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess if FDG PET combined with diagnostic CT improves diagnostic CT accuracy to detect lymph node (LN) metastasis in advanced cervical cancer. METHODS A prospective HIPAA compliant ACRIN/GOG multicenter trial was conducted. Patients underwent concurrent diagnostic contrast-enhanced CT (DCT) and PET and pelvic/abdominal lymphadenectomy. Seven independent blinded readers reviewed PET-DCT and DCT one-month apart. Reference standard was surgically removed LN pathology. Accuracy values were calculated at participant level, correlating abdominal (right and left para-aortic/common iliac) and pelvic (right and left external iliac/obturator) LN regions with pathology, respecting laterality. Reader average sensitivities/specificities of PET-DCT vs. DCT were compared with generalized linear mixed models, and AUCs with Obuchowski's method. RESULTS One hundred fifty-three patients had PET-DCT and pathology. Forty-three of 153 patients had metastasis to abdominal LNs. Sample size calculation required review of the first 40 abdominal positive and 40 randomly selected abdominal negative studies. Patients were 24 to 74years (48.9±10.6) old. Mean sensitivities of PET-DCT/DCT for detection of LN metastasis in abdomen were 0.50 (CI: 0.44, 0.56) and 0.42 (CI: 0.36, 0.48) (p=0.052) and in pelvis 0.83 (CI: 0.78, 0.87) and 0.79 (CI: 0.73, 0.83) (p=0.15). Corresponding specificities were 0.85 (CI: 0.80, 0.89) and 0.89 (CI: 0.84, 0.92) (p=0.21) and 0.63 (CI: 0.54, 0.70) and 0.62 (CI: 0.53, 0.69) (p=0.83). Mean AUC values were 0.70 (CI: 0.61, 0.79) and 0.68 (CI: 0.59, 0.77) (p=0.43) and 0.80 (CI: 0.71, 0.88) and 0.76 (CI: 0.67, 0.85) (p=0.21) respectively. CONCLUSION Addition of PET to DCT resulted in statistically borderline increase in sensitivity to detect LN metastasis in abdomen in advanced cervical cancer.
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Affiliation(s)
| | | | | | | | | | | | | | - Kathleen Moore
- University of Oklahoma Health Science Center, United States
| | - Lisa Landrum
- University of Oklahoma Health Science Center, United States
| | - Jae Weon Kim
- Seoul National University College of Medicine, Republic of Korea
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Bagade S, Fowler KJ, Schwarz JK, Grigsby PW, Dehdashti F. PET/MRI Evaluation of Gynecologic Malignancies and Prostate Cancer. Semin Nucl Med 2016; 45:293-303. [PMID: 26050657 DOI: 10.1053/j.semnuclmed.2015.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PET combined with cross-sectional anatomical imaging is an essential part of workup for most malignancies, in which CT or MRI provides anatomical context to the functional information from PET. Hybrid imaging with PET/CT has been extensively researched and implemented clinically in the evaluation and management of patients with gynecologic malignancies. Lately, integrated PET/MR scanners have become available. This new technology is fast gaining a role in clinical applications in the fields of oncology, neurology, and cardiology. MRI provides excellent soft tissue contrast especially in the pelvis and has been proven very useful for imaging prostate and female genital pathologies. The ability of PET to provide accurate functional imaging data with high sensitivity combined with the strength of MRI to provide accurate depiction of anatomy with high contrast and spatial resolution renders combined PET/MRI a desirable method for evaluation of gynecologic malignancies and other pelvic cancers such as prostate cancer. The goal of this article is to provide an overview of the published literature using PET/MRI in gynecologic and prostate cancers.
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Affiliation(s)
- Swapnil Bagade
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Kathryn J Fowler
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO; Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - Julie K Schwarz
- Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO; Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Perry W Grigsby
- Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO; Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Farrokh Dehdashti
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO; Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO.
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Naoura I, Laas E, Beytout C, Bendifallah S, Ballester M, Daraï E. [A propensity score evaluation of single-port or multiport extraperitoneal para-aortic lymphadenectomy and the transperitoneal approach for gynecological cancers]. Bull Cancer 2016; 103:320-9. [PMID: 26920042 DOI: 10.1016/j.bulcan.2016.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 12/27/2015] [Accepted: 01/09/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Endoscopic para-aortic lymphadenectomy (PALN) is a crucial step in the management of gynecological cancers. However, some concerns exist on the completeness of PALN according to the route (transperitoneal vs. extraperitoneal single-port or multiport). We compared these three surgical techniques using a propensity score. METHODS We retrospectively reviewed all patients undergoing an endoscopic PALN for a gynecological cancer from May 2010 to Mars 2015. Fifty-one patients had a single-port extraperitoneal PALN, 16 a multiport extraperitoneal PALN and 62 a transperitoneal PALN. Factors independently related to technique performances were tested on a multivariate model adjusted for a propensity score. RESULTS The number of lymph nodes removed by transperitoneal route was 15 and extraperitoneal route single and multiport was 12. After adjustment for the propensity score of undergoing the extraperitoneal approach, no difference in the number of lymph node removed was noted (P=0.17). There was more lymphocyst after transperitoneal (17%) and multiport extraperitoneal PALN (19%) than after extraperitoneal PALN (2%) (P=0.04). Success rate of single-port extraperitoneal PALN was 94% (n=48). Four patients required a conversion to an open route due to vascular injury. DISCUSSION Using a propensity score, single-port extraperitoneal route offers similar efficacy to perform PALN than transperitoneal or multiport extraperitoneal route but with less lymphocysts.
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Affiliation(s)
- Iptissem Naoura
- Assistance publique-Hôpitaux de Paris, institut universitaire de cancérologie, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, Department of Gynaecology and Obstetrics, 75020 Paris, France.
| | - Enora Laas
- Assistance publique-Hôpitaux de Paris, institut universitaire de cancérologie, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, Department of Gynaecology and Obstetrics, 75020 Paris, France
| | - Clémentine Beytout
- Assistance publique-Hôpitaux de Paris, institut universitaire de cancérologie, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, Department of Gynaecology and Obstetrics, 75020 Paris, France
| | - Sofiane Bendifallah
- Assistance publique-Hôpitaux de Paris, institut universitaire de cancérologie, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, Department of Gynaecology and Obstetrics, 75020 Paris, France
| | - Marcos Ballester
- Assistance publique-Hôpitaux de Paris, institut universitaire de cancérologie, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, Department of Gynaecology and Obstetrics, 75020 Paris, France; Inserm UMRS-938, 75011 Paris, France
| | - Emile Daraï
- Assistance publique-Hôpitaux de Paris, institut universitaire de cancérologie, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, Department of Gynaecology and Obstetrics, 75020 Paris, France; Inserm UMRS-938, 75011 Paris, France
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Beytout C, Laas E, Naoura I, Bendifallah S, Canlorbe G, Ballester M, Daraï E. Single-Port Extra- and Transperitoneal Approach for Paraaortic Lymphadenectomy in Gynecologic Cancers: A Propensity-Adjusted Analysis. Ann Surg Oncol 2015; 23:952-8. [DOI: 10.1245/s10434-015-4874-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Indexed: 11/18/2022]
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18F-FDG-PET/CT is of limited value in primary staging of early stage cervical cancer. ACTA ACUST UNITED AC 2015; 40:127-33. [PMID: 25015401 DOI: 10.1007/s00261-014-0194-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess the clinical benefit of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG-PET/CT) in evaluating pelvic lymph nodes in patients with early stage cervical cancer (FIGO stage 1a–1b1), who have magnetic resonance imaging (MRI)-defined lymph node negative disease, with histopathologic results as the reference standard. MATERIALS AND METHODS We assessed one hundred and seventy nine sequential 18F-FDG-PET/CT scans in women with newly diagnosed cervical carcinoma between January 2009 and September 2011. 47 of these patients had early stage disease (FIGO stage 1a–1b1) with no suspicious lymph nodes on MRI. 18F-FDG-PET/CT images were analyzed and histopathological findings (pelvic lymph node resection) served as the reference standard. RESULTS The median age of patients was 48 (range 22–86) years. 66 % had squamous histotype. Median number of nodes dissected per patient was 21 (range 8–47), 2 of 47 patients had nodal metastases (4.25 %). All patients in this group had no suspicious lymph nodes on 18F-FDG-PET/CT. Overall patient based sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 18F-FDG-PET/CT for detection of nodal disease were 0 %, 100 %, 0 %, 96 %, and 96 % respectively. CONCLUSION Pathologic validation of 18F-FDG-PET/CT imaging demonstrates little value for 18F-FDG-PET/CT in patients with early stage (FIGO stage 1a–1b1) MRI-defined lymph node negative cervical carcinoma. Since the likelihood of metastatic nodal disease is very low in women with stage 1a–1b1 cervical cancer, we believe that 18F-FDG-PET/CT should not have a role in the routine pre-treatment evaluation of these women.
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Extraperitoneal Para-aortic Lymphadenectomy by Robot-Assisted Laparoscopy in Gynecologic Oncology. Int J Gynecol Cancer 2015; 25:1494-502. [DOI: 10.1097/igc.0000000000000504] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Extraperitoneal Lymphadenectomy in the Management of Gynecologic Cancer. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2015. [DOI: 10.1007/s13669-015-0124-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hansen HV, Loft A, Berthelsen AK, Christensen IJ, Høgdall C, Engelholm SA. Survival outcomes in patients with cervical cancer after inclusion of PET/CT in staging procedures. Eur J Nucl Med Mol Imaging 2015; 42:1833-9. [DOI: 10.1007/s00259-015-3113-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 06/07/2015] [Indexed: 11/29/2022]
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Abstract
FDG-PET/CT has been evaluated in a variety of gynecologic malignancies in a variety of settings and is approved by the Centers for Medicare & Medicaid Services for the initial and subsequent treatment strategies of these malignancies. Cervical cancer is typically very FDG avid, and FDG-PET/CT appears to be most valuable for initial staging, radiation therapy planning, and detection of recurrent disease. For ovarian cancer, the most value of FDG-PET/CT appears to be for detecting recurrent disease in the setting of rising CA-125 level and negative or equivocal anatomical imaging studies. Initial studies evaluating response to therapy are promising and further work in this area is needed. FDG uptake in both nonmalignant and physiological processes in the pelvis can make interpretation of FDG-PET/CT in this region challenging and knowledge of these entities and patterns can avoid misinterpretation. Some of the most common findings relate to the cyclic changes that occur as part of the menstrual cycle in premenopausal women. Mucinous tumors and low-volume or peritoneal carcinomatosis are causes of false-negative results on FDG-PET/CT studies. As new tracers are developed, comparisons with patient outcomes and standards of care (eg, FDG-PET/CT) will be needed.
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Affiliation(s)
- Paul Grant
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Department of Radiology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Christopher Sakellis
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Department of Radiology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Heather A Jacene
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Department of Radiology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
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Preoperative PET/CT FDG standardized uptake value of pelvic lymph nodes as a significant prognostic factor in patients with uterine cervical cancer. Eur J Nucl Med Mol Imaging 2014; 41:674-81. [PMID: 24233005 DOI: 10.1007/s00259-013-2626-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 10/31/2013] [Indexed: 12/28/2022]
Abstract
PURPOSE Using integrated PET/CT, we evaluated the prognostic relevance in uterine cervical cancer of preoperative pelvic lymph node (LN) [(18)F]FDG uptake. METHODS Patients with FIGO stage IB to IIA uterine cervical cancer were imaged with FDG PET/CT before radical surgery. We used Cox proportional hazards regression to examine the relationship between recurrence and the FDG maximum standardized uptake value (SUV(max)) in the pelvic LN (SUVLN) on PET/CT. RESULTS Clinical data, treatment modalities, and results in 130 eligible patients were reviewed. The median postsurgical follow-up was 34 months (range 6 to 109 months). Receiver operating characteristic analysis identified SUVLN 2.36 as the most significant cut-off value for predicting recurrence. SUV(LN) was correlated with SUV(tumour) (P = 0.002), primary tumour size (P = 0.004), and parametrial invasion (P = 0.013). Univariate analyses showed significant associations between recurrence and SUV(LN) (P = 0.001), SUV(tumour) (P = 0.007), pelvic LN metastasis (P = 0.002), parametrial invasion (P < 0.001), primary tumour size (P = 0.007), suspected LN metastasis on MRI (P = 0.024), and FIGO stage (P = 0.026). Multivariate analysis identified SUV(LN) (P = 0.013, hazard ratio, HR, 4.447, 95 % confidence interval, CI, 1.379 – 14.343) and parametrial invasion (P = 0.013, HR 6.728, 95 % CI 1.497 – 30.235) as independent risk factors for recurrence. Patients with SUV(LN) ≥ 2.36 and SUV(LN) <2.36 differed significantly in terms of recurrence (HR 15.20, P < 0.001). CONCLUSION Preoperative pelvic LN FDG uptake showed a strong significant association with uterine cervical cancer recurrence.
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Fleming S, Cooper RA, Swift SE, Thygesen HH, Chowdhury FU, Scarsbrook AF, Patel CN. Clinical impact of FDG PET-CT on the management of patients with locally advanced cervical carcinoma. Clin Radiol 2014; 69:1235-43. [PMID: 25439186 DOI: 10.1016/j.crad.2014.07.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 06/18/2014] [Accepted: 07/04/2014] [Indexed: 11/19/2022]
Abstract
AIM To evaluate the impact of staging FDG PET-CT on the initial management of patients with locally advanced cervical carcinoma (LACC) and any prognostic variables predicting survival. MATERIALS AND METHODS Retrospective analysis of consecutive patients undergoing FDG PET-CT for staging of LACC in a single tertiary referral centre, between April 2008 and August 2011. Comparison was made between MRI and PET-CT findings and any subsequent impact on treatment intent or radiotherapy planning was evaluated. RESULTS Sixty-three patients underwent FDG PET-CT for initial staging of LACC. Major impact on management was found in 20 patients (32%), a minor impact in five (8%), and no impact in 38 (60%). In those patients where PET-CT had a major impact, 12 had more extensive local nodal involvement, five had occult metastatic disease, two had synchronous tumours, and one patient had equivocal lymph nodes on MRI characterized as negative. PET-positive nodal status at diagnosis was found to be a statistically significant predictor of relapse-free survival (p < 0.05). CONCLUSION Staging FDG PET-CT has a major impact on the initial management of approximately one-third of patients with LACC by altering treatment intent and/or radiotherapy planning. PET-defined nodal status is a poor prognostic indicator.
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Affiliation(s)
- S Fleming
- Department of Clinical Radiology, St James's University Hospital, Leeds, UK
| | - R A Cooper
- Department of Clinical Oncology, St James's University Hospital, Leeds, UK
| | - S E Swift
- Department of Clinical Radiology, St James's University Hospital, Leeds, UK
| | - H H Thygesen
- Leeds Cancer Research UK Centre, St James's University Hospital, Leeds, UK
| | - F U Chowdhury
- Department of Clinical Radiology, St James's University Hospital, Leeds, UK; Department of Nuclear Medicine, St James's University Hospital, Leeds, UK
| | - A F Scarsbrook
- Department of Clinical Radiology, St James's University Hospital, Leeds, UK; Department of Nuclear Medicine, St James's University Hospital, Leeds, UK
| | - C N Patel
- Department of Clinical Radiology, St James's University Hospital, Leeds, UK; Department of Nuclear Medicine, St James's University Hospital, Leeds, UK.
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Pretreatment Retroperitoneal Para-aortic Lymph Node Staging in Advanced Cervical Cancer: A Review. Int J Gynecol Cancer 2014; 24:973-83. [DOI: 10.1097/igc.0000000000000177] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveThe aims of this study were to evaluate the safety and impact of pretreatment surgical para-aortic lymph node staging (PALNS) in advanced cervical cancer (International Federation of Gynecology and Obstetrics stage IB2-IVA) and to evaluate the preoperative imaging of PALNs.MethodsWe searched in PubMed and the Cochrane Library to identify data investigating the role of surgical PALNS. Selection criteria included English-language and advanced-stage cervical cancer (International Federation of Gynecology and Obstetrics stage IB2-IVA) articles.ResultsTwenty-two articles were included. Para-aortic lymph node metastases were present in 18% (range, 8%–42%) of all patients with cervical cancer stage IB to IVA. The proportions of positive para-aortic nodes on histological analysis with suspicious para-aortic nodes on imaging (positive predictive value) were 20% to 66%, 0% to 27%, 86% to 100%, and 50% to 75% for computed tomographic (CT) scan, magnetic resonance imaging (MRI) scan, positron emission tomography (PET), and PET-CT, respectively. The negative predictive values of the imaging techniques were 53% to 92% for CT scan, 75% to 91% for MRI, 87% to 94% for PET, and 83% to 92% for PET-CT. The proportions of histologically proven PALN metastasis with normal findings on imaging were 9% to 35% for CT scan and MRI, 4% to 11% for PET, and 6% to 15% for PET-CT. The mean complication rate of PALNS is 9%, with a range of 4% to 24%, with lymphocysts being the most common complication.ConclusionsPretreatment surgical PALN dissection or sampling is feasible, with low complication rates and short delay in starting treatment. Pretreatment PET or PET-CT is the most accurate imaging method in detecting PALN metastases but has limitations detecting microscopic tumor volumes. Even with normal findings on PET-CT, PALN metastases are present in 4% to 15% of patients. Positive PALNs in stage IB2 to IVA cervical cancer will lead to modification of treatment and may lead to better overall and disease-free survival.
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Lazzari R, Cecconi A, Jereczek-Fossa BA, Travaini LL, Dell' Acqua V, Cattani F, Rizzo S, Fodor C, Landoni F, Orecchia R. The role of [(18)F]FDG-PET/CT in staging and treatment planning for volumetric modulated Rapidarc radiotherapy in cervical cancer: experience of the European Institute of Oncology, Milan, Italy. Ecancermedicalscience 2014; 8:405. [PMID: 24688597 PMCID: PMC3963705 DOI: 10.3332/ecancer.2014.409] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Indexed: 11/06/2022] Open
Abstract
RATIONALE to evaluate the role of 18F-fluorodeoxyglucose positron emission tomography ([(18)F]FDG-PET) integrated with computer tomography (CT) scan [(18)F]FDG-PET/CT in the staging and target volume definition in Intensity Modulated RapidarcTM Delivery (RA-IMRT) in cervical cancer. METHODS From June 2010 to December 2011, 66 patients affected by cervical cancer, candidates for definitive or adjuvant radiochemotherapy, underwent standard staging with CT and magnetic resonance imaging (MRI). All patients underwent [(18)F]FDG-PET/CT in order to exclude distant metastases and to define gross tumor volume (GTV). 40 and 26 patients received exclusive and adjuvant radiotherapy, respectively. RA-IMRT with simultaneous integrated boost (SIB) to the positive disease technique was employed. RESULTS [(18)F]FDG-PET/CT has changed the stage, and radiotherapy treatment planning was modified in 25% and 7.7 % of patients that received definitive and adjuvant radiotherapy, respectively. Particularly [(18)F]FDG-PET/CT imaging showed metabolically active tumor in lymph nodes area, therefore the stage and the treatment planning changed for these patients. CONCLUSIONS [(18)F]FDG-PET/CT leads to a better staging and definition of disease and has the potential of showing lymph-node metastasis not only within the pelvis but also in the para-aortic area. In addition, [(18)F]FDG-PET/CT is useful for better definition of the target volume and to produce a 'dose painted' treatment. This might also open the field for escalation dose regimens.
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Affiliation(s)
- Roberta Lazzari
- Advanced Radiotherapy Centre, European Institute of Oncology, Milan 20141, Italy
| | - Agnese Cecconi
- Advanced Radiotherapy Centre, European Institute of Oncology, Milan 20141, Italy
| | - Barbara A Jereczek-Fossa
- Advanced Radiotherapy Centre, European Institute of Oncology, Milan 20141, Italy ; University of Milan, Milan 20122, Italy
| | | | - Veronica Dell' Acqua
- Advanced Radiotherapy Centre, European Institute of Oncology, Milan 20141, Italy
| | - Federica Cattani
- Medical Physics Division, European Institute of Oncology, Milan 20141, Italy
| | - Stefania Rizzo
- Radiology Division, European Institute of Oncology, Milan 20141, Italy
| | - Cristiana Fodor
- Advanced Radiotherapy Centre, European Institute of Oncology, Milan 20141, Italy
| | - Fabio Landoni
- Cervical Cancer Centre, Division of Gynaecologic Cancer Surgery, European Institute of Oncology, Milan 20141, Italy
| | - Roberto Orecchia
- Advanced Radiotherapy Centre, European Institute of Oncology, Milan 20141, Italy ; University of Milan, Milan 20122, Italy
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Complications After the Treatment of Endometrial Cancer: A Prospective Study Using the French-Italian Glossary. Int J Gynecol Cancer 2014; 24:418-26. [DOI: 10.1097/igc.0000000000000094] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IntroductionThe evaluation of treatment complications is crucial in modern oncology because they heavily influence the every day life of patients. Several authors confirmed the reproducibility of the French-Italian glossary to score the complications in patients with endometrial cancer after radiotherapy (RT), but the treatment of endometrial carcinoma is primarily surgical and chemotherapy is often used for high-risk disease.ObjectivesThis study aimed to analyze the incidence of complications in our patients treated for endometrial cancer and to verify whether the glossary is a suitable instrument in the description of complications after surgery, RT, and chemotherapy.MethodsThe data of patients affected by endometrial cancer treated in the Gynecology and Obstetrics Academic Department, Azienda Ospedaliera Mauriziano Umberto I in Turin from 2000 to 2009 (with surgery alone or integrated treatments) were prospectively collected, and complications were described using the glossary. Every patient included in the analyses had a minimum of 18 months follow-up.ResultsOf the 271 patients, 68 (25%) experienced at least 1 complication with 87 overall complications. Most of the complications were mild (63%) and were found in the urinary (30%) or cutaneous systems (30%). Forty-four (50%) complications appeared within 1 year after treatment, but 9 (10%) complications appeared after 60 months of follow-up. Patients who were submitted to both surgery and RT showed a trend of higher rate of at least 1 complication (19/58 [32.7%]) if compared with surgery alone (36/135 [26.6%]), even if the difference was not statistically significant (P = 0.09). The incidence of complications in patients treated or not with lymphadenectomy was not statistically different (P = 0.088), whereas patients treated with laparotomy had a higher rate of cutaneous complications if compared with the laparoscopic approach (P = 0.018). The glossary included all observed complications.ConclusionsOne every 4 women treated for endometrial cancer develops a complication. Clinicians should check for complications especially after integrated treatments maintaining surveillance even in the long term. The glossary is a comprehensive instrument to describe the complications of endometrial cancer, regardless of the type of treatment delivered.
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Lai CH, Yen TC. When and how often should PET scans be performed in the management of cervical cancer? Expert Rev Anticancer Ther 2014; 10:983-6. [DOI: 10.1586/era.10.78] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
OBJECTIVE. Cervical cancer is the second most common malignancy in women worldwide and the third most common cause of cancer mortality in the United States. The aim of this article is to describe cervical cancer and outline the value of (18)F-FDG PET/CT in the management of cervical malignancy. CONCLUSION. The value of PET/CT has been found in staging and treatment strategy for cervical cancer. FDG PET/CT facilitates decision-making and radiation treatment planning and provides important information about treatment response, disease recurrence, and long-term survival.
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Single-port laparoscopy and extraperitoneal para-aortic lymphadenectomy for locally advanced cervical cancer: assessment after 52 consecutive patients. Surg Endosc 2013; 28:249-56. [DOI: 10.1007/s00464-013-3180-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 08/08/2013] [Indexed: 10/26/2022]
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Gouy S, Morice P, Narducci F, Uzan C, Gilmore J, Kolesnikov-Gauthier H, Querleu D, Haie-Meder C, Leblanc E. Nodal-staging surgery for locally advanced cervical cancer in the era of PET. Lancet Oncol 2012; 13:e212-20. [PMID: 22554549 DOI: 10.1016/s1470-2045(12)70011-6] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Chemoradiation therapy is deemed the standard treatment by many North American and European teams for treatment of locally advanced cervical cancer. The prevalence of para-aortic nodal metastasis in these tumours is 10-25%. PET (with or without CT) is the most accurate imaging modality to assess extrapelvic disease in such tumours. The true-positive rate of PET is high, suggesting that surgical staging is not necessary if uptake takes place in the para-aortic region. Nevertheless, false-negative results (in the para-aortic region) have been recorded in 12% of patients, rising to 22% in those with uptake during PET of the pelvic nodes. In such situations, laparoscopic surgical para-aortic staging still has an important role for detection of patients with occult para-aortic spread misdiagnosed on PET or PET-CT, allowing optimisation of treatment (extension of radiation therapy fields to include the para-aortic area). Complications of the laparoscopic procedure were noted in 0-7% of patients. Survival of individuals (missed by PET) with para-aortic nodal metastasis of 5 mm or less (and managed by extended field chemoradiation therapy) seems to be similar to survival of those without para-aortic spread, suggesting a positive therapeutic effect of the addition of staging surgery. Nevertheless, the effect on survival of potential delay of chemoradiation owing to use of PET and staging surgery, and acute and late complications of surgery followed by chemoradiation therapy (particularly in case of extended field chemoradiation to para-aortic area), need to be studied.
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Affiliation(s)
- Sebastien Gouy
- Department of Gynaecological Surgery, Institut Gustave Roussy, Villejuif, France
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ACR Appropriateness Criteria® Pretreatment Planning of Invasive Cancer of the Cervix. J Am Coll Radiol 2012; 9:395-402. [DOI: 10.1016/j.jacr.2012.02.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 02/27/2012] [Indexed: 11/19/2022]
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Salem A, Salem AF, Al-Ibraheem A, Lataifeh I, Almousa A, Jaradat I. Evidence for the use PET for radiation therapy planning in patients with cervical cancer: a systematic review. Hematol Oncol Stem Cell Ther 2012; 4:173-81. [PMID: 22198188 DOI: 10.5144/1658-3876.2011.173] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVE In recent years, the role of positron emission tomography (PET) in the staging and management of gynecological cancers has been increasing. The aim of this study was to systematically review the role of PET in radiotherapy planning and brachytherapy treatment optimization in patients with cervical cancer. DESIGN AND SETTING Systematic literature review. METHODS Systematic review of relevant literature addressing the utilization of PET and/or PET-computed tomography (CT) in external-beam radiotherapy planning and brachytherapy treatment optimization. We performed an extensive PubMed database search on 20 April 2011. Nineteen studies, including 759 patients, formed the basis of this systematic review. RESULTS PET/ PET-CT is the most sensitive imaging modality for detecting nodal metastases in patients with cervical cancer and has been shown to impact external-beam radiotherapy planning by modifying the treatment field and customizing the radiation dose. This particularly applies to detection of previously uncovered para-aortic and inguinal nodal metastases. Furthermore, PET/ PET-CT guided intensity-modulated radiation therapy (IMRT) allows delivery of higher doses of radiation to the primary tumor, if brachytherapy is unsuitable, and to grossly involved nodal disease while minimizing treatment-related toxicity. PET/ PET-CT based brachytherapy optimization allows improved tumor-volume dose distribution and detailed 3D dosimetric evaluation of risk organs. Sequential PET/ PET-CT imaging performed during the course of brachytherapy form the basis of âadaptiveâ brachytherapy in cervical cancer. CONCLUSIONS This review demonstrates the effectiveness of pretreatment PET/ PET-CT in cervical cancer patients treated by radiotherapy. Further prospective studies are required to define the group of patients who would benefit the most from this procedure.
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Affiliation(s)
- A Salem
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
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Signorelli M, Guerra L, Montanelli L, Crivellaro C, Buda A, Dell'Anna T, Picchio M, Milani R, Fruscio R, Messa C. Preoperative staging of cervical cancer: Is 18-FDG-PET/CT really effective in patients with early stage disease? Gynecol Oncol 2011; 123:236-40. [DOI: 10.1016/j.ygyno.2011.07.096] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Revised: 07/04/2011] [Accepted: 07/26/2011] [Indexed: 10/17/2022]
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Mittra E, El-Maghraby T, Rodriguez CA, Quon A, McDougall IR, Gambhir SS, Iagaru A. Efficacy of 18F-FDG PET/CT in the evaluation of patients with recurrent cervical carcinoma. Eur J Nucl Med Mol Imaging 2011; 36:1952-9. [PMID: 19585114 DOI: 10.1007/s00259-009-1206-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 06/12/2009] [Indexed: 11/29/2022]
Abstract
PURPOSE Only a limited number of studies have evaluated the efficacy of 18F-FDG PET/CT for recurrent cervical carcinoma, which this study seeks to expand upon. METHODS This is a retrospective study of 30 women with cervical carcinoma who had a surveillance PET/CT after initial therapy. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated using a 2 × 2 contingency table with pathology results (76%) or clinical follow-up (24%) as the gold standard. The Wilson score method was used to perform 95% confidence interval estimations. RESULTS The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of PET/CT for the detection of local recurrence at the primary site were 93, 93, 93, 86, and 96%, respectively. The same values for the detection of distant metastases were 96, 95, 95, 96, and 95%, respectively. Seventy-one percent of the scans performed in symptomatic patients showed true-positive findings. In comparison, 44% of scans performed in asymptomatic patients showed true-positive findings. But, all patients subsequently had a change in their management based on the PET/CT findings such that the effect was notable. The maximum standardized uptake value ranged from 5 to 28 (average: 13 ± 7) in the primary site and 3 to 23 (average: 8 ± 4) in metastases which were significantly different (p = 0.04). CONCLUSION This study demonstrates favorable efficacy of 18F-FDG PET/CT for identification of residual/recurrent cervical cancer, as well as for localization of distant metastases.
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Affiliation(s)
- Erik Mittra
- Division of Nuclear Medicine, Stanford Hospitals & Clinics, 300 Pasteur Dr, Room H-0101, Stanford, CA 94305, USA
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Kitajima K, Suzuki K, Senda M, Kita M, Nakamoto Y, Sakamoto S, Onishi Y, Maeda T, Yoshikawa T, Ohno Y, Suganuma N, Sugimura K. Preoperative nodal staging of uterine cancer: is contrast-enhanced PET/CT more accurate than non-enhanced PET/CT or enhanced CT alone? Ann Nucl Med 2011; 25:511-9. [DOI: 10.1007/s12149-011-0496-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 04/18/2011] [Indexed: 10/18/2022]
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47
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Leblanc E, Gauthier H, Querleu D, Ferron G, Zerdoud S, Morice P, Uzan C, Lumbroso S, Lecuru F, Bats AS, Ghazzar N, Bannier M, Houvenaeghel G, Brenot-Rossi I, Narducci F. Accuracy of 18-fluoro-2-deoxy-D-glucose positron emission tomography in the pretherapeutic detection of occult para-aortic node involvement in patients with a locally advanced cervical carcinoma. Ann Surg Oncol 2011; 18:2302-9. [PMID: 21347790 DOI: 10.1245/s10434-011-1583-9] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Indexed: 01/12/2023]
Abstract
PURPOSE Patients with locally advanced cervical cancer (LACC) are usually treated with concurrent chemoradiotherapy. Extended-field chemoradiotherapy is indicated in case of para-aortic node involvement at initial assessment. 18-Fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18-FDG PET/CT) is currently considered to be the most accurate method of detection of node or distant metastases. The goal of this study was to evaluate the accuracy of PET at detecting para-aortic lymph node metastases in LACC patients with a negative morphological imaging. METHODS Patients from five French institutions with LACC and both negative morphologic (magnetic resonance imaging, CT scan) and functional (PET or PET/CT) findings at the para-aortic level and distantly were submitted to a systematic infrarenal para-aortic node dissection either by laparoscopy or laparotomy. On the basis of pathological results, sensitivity, specificity, and positive and negative predictive values of PET/CT were assessed for para-aortic lymph node involvement. RESULTS A total of 125 LACC patients (stage IB2-IVA disease with two local recurrences) fulfilled the inclusion criteria. All had an ilio-infrarenal para-aortic lymphadenectomy, either by laparoscopy (n = 117) or laparotomy (n = 8). Twenty-one patients (16.8%) had pathologically proven para-aortic metastases. Among them, 14 (66.7%) had negative PET/CT. Overall morbidity of surgery was 7.2%. All but one of the complications were mild and did not delay chemoradiotherapy. Sensitivity, specificity, and positive and negative predictive value of the PET/CT were 33.3, 94.2, 53.8, and 87.5%, respectively, for the detection of microscopic lymph node metastases. CONCLUSIONS Laparoscopic staging surgery seems warranted in LACC patients with negative PET scan who are candidates for definitive concurrent chemoradiotherapy or exenteration.
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Affiliation(s)
- E Leblanc
- Centre Oscar Lambret, Lille, France.
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Kitajima K, Murakami K, Kaji Y, Sakamoto S, Sugimura K. Established, emerging and future applications of FDG-PET/CT in the uterine cancer. Clin Radiol 2011; 66:297-307. [PMID: 21356392 DOI: 10.1016/j.crad.2010.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 07/12/2010] [Accepted: 07/18/2010] [Indexed: 10/18/2022]
Abstract
Integrated positron emission tomography/computed tomography (PET/CT) with 2-[¹⁸F]fluoro-2-deoxy-D-glucose (FDG) is a useful technique to acquire both glucose metabolic and anatomic imaging data using a single device in a single diagnostic session and has opened a new field in clinical oncologic imaging. FDG-PET/CT has been used successfully for the staging, optimization of treatment, re-staging, therapy monitoring, and prognostic prediction of uterine cervical cancer and endometrial cancer as well as various malignant tumours. The present review discusses the current role of FDG-PET/CT in the management of uterine cancer, discussing its usefulness and limitations in the imaging of these patients.
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Affiliation(s)
- K Kitajima
- PET Diagnosis, Institute of Biomedical Research and Innovation, Kobe, Japan.
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Ramirez PT, Jhingran A, Macapinlac HA, Euscher ED, Munsell MF, Coleman RL, Soliman PT, Schmeler KM, Frumovitz M, Ramondetta LM. Laparoscopic extraperitoneal para-aortic lymphadenectomy in locally advanced cervical cancer: a prospective correlation of surgical findings with positron emission tomography/computed tomography findings. Cancer 2010; 117:1928-34. [PMID: 21509770 DOI: 10.1002/cncr.25739] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 09/17/2010] [Accepted: 09/28/2010] [Indexed: 01/12/2023]
Abstract
BACKGROUND Failure to detect metastasis to para-aortic nodes in patients with locally advanced cervical cancer leads to suboptimal treatment. No previous studies have prospectively compared positron emission tomography (PET)/computed tomography (CT) with laparoscopic extraperitoneal staging in the evaluation of para-aortic lymph nodes. METHODS Sixty-five patients were enrolled; 60 were available for analysis. Patients with stage IB2-IVA cervical cancer without evidence of para-aortic lymphadenopathy on preoperative CT or magnetic resonance imaging (MRI) were prospectively enrolled. All patients underwent preoperative PET/CT. Laparoscopic extraperitoneal lymphadenectomy was performed from the common iliac vessels to the left renal vein. RESULTS The median age at diagnosis was 48 years (range, 23-84). The median operative time was 140 minutes (range, 89-252). The median blood loss was 22.5 mL (range, 5-150). The median length of hospital stay was 1 day (range, 0-4). The median number of lymph nodes retrieved was 11 (range, 1-39). Fourteen (23%) patients had histopathologically positive para-aortic nodes. Of the 26 patients with negative pelvic and para-aortic nodes on PET/CT, 3 (12%) had histopathologically positive para-aortic nodes. Of the 27 patients with positive pelvic but negative para-aortic nodes on PET/CT, 6 (22%) had histopathologically positive para-aortic nodes. The sensitivity and specificity of PET/CT in detecting positive para-aortic nodes when nodes were negative on CT or MRI were 36% and 96%, respectively. Eleven (18.3%) patients had a treatment modification based on surgical findings. CONCLUSIONS Laparoscopic extraperitoneal para-aortic lymphadenectomy is safe and feasible. Surgical staging of patients with locally advanced cervical cancer should be considered before planned radiation and chemotherapy.
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Affiliation(s)
- Pedro T Ramirez
- Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Son H, Kositwattanarerk A, Hayes MP, Chuang L, Rahaman J, Heiba S, Machac J, Zakashansky K, Kostakoglu L. PET/CT Evaluation of Cervical Cancer: Spectrum of Disease. Radiographics 2010; 30:1251-68. [DOI: 10.1148/rg.305105703] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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