Introduction/Background*The most important prognostic factor in cervical cancer is lymph node involvement. Up to 24% of patients with a negative CT scan show histological lymph node disease.The gold standard is histopathological study,but surgery is not exempt from possible complications (even laparoscopic approach). We intend to know the sensitivity and specificity of PET/CT in paraortic lymph node staging in LACC with negative CT.
Methodology Retrospective study of patients with LACC who have undergone laparoscopic paraortic lymphadenectomy and previously had performed a PET/CT. The indication for paraortic surgical staging in patients with LACC is a negative CT scan for disease at the paraortic level.
Result(s)*The mean age of the patients with cervical cancer was 52.7 years (range 23-97 years). 69% were in advanced stages at the time of diagnosis. It should be noted that 35.5% of patients diagnosed in advanced stages underwent paraortic surgical staging. We have performed 227 laparoscopic paraortic lymphadenectomies in patients with LACC, 14% with metastatic involvement. In 52 patients we had a PET/CT prior to paraortic lymphadenectomy. In the group of patients with negative PET (n = 45), we found that surgical staging was negative in 95.5% (n = 43). Meanwhile in patients with positive PET at the paraortic level (n = 7), we found that in 4 cases it was confirmed lymph node involvement in histology and in 3 cases they were false positives (predictive value 57.2% positive)
Conclusion*The specificity of PET/CT for paraortic lymph node staging in LCCA with Negative CT scan is 93.4%, and the sensitivity is 66.6% in our series. If this trend is confirmed, we could consider modifying our strategy in the indication for paraortic surgical staging: in case of advanced stages with negative CT and PET/CT for lymphatic involvement , do not perform paraortic lymphadenectomy (negative predictive value of 95.5%) and in cases of negative CT and positive PET, consider performing lymphadenectomy paraortic (positive predictive value of 57.2%).
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