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Prospective Evaluation of 18-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography for the Discrimination of Paraaortic Nodal Spread in Patients With Locally Advanced Cervical Carcinoma
  1. Tirso Perez-Medina, Prof, PhD*,
  2. Augusto Pereira, PhD*,
  3. Jorge Mucientes, MD,
  4. Manuel García-Espantaleón, MD*,
  5. Jesús S. Jiménez, PhD,
  6. Laura Calles, MD*,
  7. Begoña Rodríguez, MD and
  8. Enrique Iglesias, Prof*
  1. *Departments of Obstetrics and Gynecology,
  2. Nuclear Medicine, Autónoma University of Madrid, Puerta de Hierro University Hospital; and
  3. 12 de Octubre University Hospital, Madrid, Spain.
  1. Address correspondence and reprint requests to Tirso Perez-Medina, PhD, Autónoma University of Madrid, Puerta de Hierro University Hospital, Manuel de Falla St, 2, 28223, Madrid, Spain. E-mail: tperezm{at}


Main Objective Patients with locally advanced cervical cancer (LACC) are usually treated with concurrent chemoradiotherapy. Extended-field chemoradiotherapy is indicated in cases of paraaortic nodal spread. Nowadays, 18-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) is considered to be the most accurate image method of detection of node or distant metastases. The goal of this study was to evaluate the accuracy of FDG-PET for detecting paraaortic lymph node (PALN) spread in patients with LACC.

Methods Patients with LACC from 2 tertiary university hospitals in Madrid, Spain, were submitted to a laparoscopic infrarenal PALN dissection after FDG-PET evaluation. Based on pathologic results as gold standard, sensitivity, specificity, and positive and negative predictive values of FDG-PET were calculated thereafter for PALN metastasis.

Results A total of 52 patients with LACC fulfilled the inclusion criteria. All of them underwent a laparoscopic infrarenal paraaortic lymphadenectomy. Eighteen patients (34.6%) had pathologically proven PALN metastases. Among them, 4 (12.5%) had negative FDG-PET (false negatives). Furthermore, 2 positive FDG-PET patients were not affected after histologic analysis (11.1% false positives). No complications occurred in our series. Sensitivity, specificity, and positive and negative predictive value of the FDG-PET were 77.7, 94.1, 87.5, and 88.9, respectively, for the detection of PALN metastases.

Conclusions The sensitivity and specificity of FDG-PET remains limited, so PALN dissection should be part of the pretherapeutic staging in every patient with LACC before definitive concurrent chemoradiotherapy.

  • Locally advanced cervical carcinoma
  • Nodal spread
  • Paraaortic lymph node dissection

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  • The authors declare no conflicts of interest.