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693 Is 18F-FDG-PET/CT an effective tool for staging cervical cancer before surgery?
  1. Joana Amengual Vila,
  2. Anna Torrent Colomer,
  3. Catalina Sampol Bas,
  4. Mario Ruiz Coll,
  5. Jorge Rioja Merlo and
  6. Octavi Cordoba
  1. Son Espases University Hospital, Palma, Spain


Introduction/Background For cervical cancer (CC) nodal status is one of the most important prognostic factors, so the recently revised FIGO staging system now includes images and pathology assessment.

18F-FDG-PET/CT is currently the most effective and precise test for nodal assessment but it could have some limitations mainly in small metastatic lymph nodes (LN).

Methodology A retrospective, observational, descriptive, single-centre study was conducted at Son Espases University Hospital from September 2018 to December 2023. Patients with early-stage and locally advancer CC (LACC) who had had 18F-FDG-PET/CT requested during their pre-treatment study were included and underwent surgical staging.

Results Early-stage CC represented 14.7% (5/34) whereas advanced-stage 85.3% (29/34).

Out of the women with LACC, 75.8% (22/29) presented 18F-FDG-PET/CT which suggested the presence of pelvic node metastasis. Of the 24% (7/29) of patients with no suspicion of pelvic nodal involvement, all had parametrial involvement. None had suspected para-aortic LN involvement.

Out of 34 patients who presented 18F-FDG-PET/CT negative for para-aortic nodal disease, 33 were true negatives. Five false-negatives were found: four patients with clinical FIGO stage IB2 turned out to have pelvic SLN metastases and were upstaged to FIGO IIIC1, while one patient with clinical stage IIIC1 had a micrometastasis in the para-aortic area. Two false positives were found: one pelvic case and one para-aortic case. 18F-FDG-PET/CT was performed again after surgery to confirm that the uptake LN had been resected.

After surgical staging, 14.7% of patients were upstaged.

Conclusion In our series, 18F-FDG-PET/CT could not detect pelvic nodal metastases in the pre-treatment study of women with early-stage CC and could be avoided. This supports the need to continue with sentinel lymph node detection.

In contrast, in cases of LACC, 18F-FDG-PET/CT showed a high prediction of para-aortic nodal status. In these cases, it should be considered whether surgical staging by para-aortic lymphadenectomy is necessary

Disclosures The authors have no conflicts of interest.

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