Introduction/Background The most important prognostic factor in cervical cancer is lymph node involvement.The available literature is unclear on the benefit of surgical staging since,although high rate of false positives,lymphadenectomy does not appear to improve survival or disease-free time.
Methodology Retrospective,observational cohort study
Aim To know the diagnostic performance of imaging tests (CT and/or PET)in the lymph node staging ofcervical cancerin our environment.To assess the prognostic impact of surgical staging on our patients.
All patients diagnosed with locally advanced cervical cancer (FIGO 2009 IB2-IVA) who underwent complete imaging and surgical staging between 2010–2021 will be included
Results There were 411 patients with LACC,of which 54.9% underwent paraortic LND.The mean age was 49.27years ± 10.5.The median BMI was 25.39kg/m2 (28.64–22.14).78.3% of cases (173)were squamous cell carcinomas,17.2% (38)adenocarcinomas, 2.7% (6)adenosquamous and 1.8% (4)undifferentiated carcinomas.The overall recurrence rate throughout the study was 15.8% (overall DFS 84.2%).Median time up to recurrence 11 months (21–1).There were no differences in recurrence patterns between patients with positive and negative nodes (p=0.137).An overall survival rate of 76.1%was observed. Average time of 27 months (42.5–11.5).70.6% (n=156)of our sample was staged by CT.26.7% (n=59)were staged by PET/CT.The rate of paraortic involvement by image was 5%(n=11).The pelvic involvement rate was 23.5%(n=52),and the involvement rate in both fields was 1.8%(n=4).Overall,the diagnostic performance of imaging staging presents a sensitivity of 14.8%,specificity of 92.6%,positive predictive value of 26.6%and NPV of 85.5%.Indirectly,there were no differences in DFS or OS in the group of patients whose treatment was modified by surgical staging.
Conclusion The diagnostic performance for paraortic lymph node involvement is limited by the low sensitivity and high rate of false negatives.This supports the performance of paraortic staging lymphadenectomy, especially in patients with imaging test with paraortic uptake,or with pelvic uptake indicative of metastasis,since we see how the probability of false negatives in the paraortic territory increases radically.
Disclosures No disclosures
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