Introduction/Background*The aim of the study was to evaluate diagnostic accuracy of ultrasound in preoperative assessment of pelvic lymph nodes (LNs) in cervical cancer patients.
Methodology Patients were retrospectively included if they met following inclusion criteria: 1) histologically verified cervical cancer; 2) preoperative ultrasound examination performed by one of three experienced sonographers (transvaginal or transrectal and transabdominal approach); 3) surgical lymph node staging (sentinel lymph node biopsy, SLNB and/or systematic pelvic lymphadenectomy, PLND or pelvic lymph node debulking). The final pathological examination served as the reference standard. Lymph nodes with macrometastases (the largest diameter > 2 mm) were considered positive, while LNs with isolated tumour cells (ITC) and micrometastases (MIC) were considered negative.
Result(s)*394 patients meeting the inclusion criteria between 2009 a 2019 were enrolled into the study. The characteristics of study population are shown in table 1. Squamous cell carcinomas were most common (298/394) and the majority of cases was represented by early stage cancers (274/394), specifically IB1 FIGO 2009 (236/394). Macrometastes in pelvic LNs were pathologically confirmed in 53 patients (13.5%) and micrometastases solely in 23 patients (5.8%). Ultrasound failed to detect pelvic lymph node macrometastases in 15 patients (3.8%) and median largest diameter of these unidentified metastases was 6 mm (range 3 – 11 mm). There were 27 false positive ultrasound findings (6.9%). Ultrasound reached sensitivity 71.7%, specificity 92.1%, PPV 58.5%, NPV 95.4% and overall accuracy 89.3%.
Conclusion*Transvaginal/transrectal ultrasound is a reliable method for preoperative assessment of pelvic LNs in cervical cancer patients. It showed similar accuracy in detection of nodal macrometastases as reported for other imaging modalities. Similarly to all imaging methods, it had low sensitivity in detection of small volume macrometastases and micrometastases.
Key words: cervical cancer, lymph nodes, ultrasound, diagnostic accuracy
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