Article Text
Abstract
Introduction/Background Treatment of locally advanced cervical cancer (LACC) is based on radical external beam radio-chemotherapy (EBRT/CHT) or exclusive chemotherapy (CT) in stage IVB. EBRT fields can be pelvic or extended depending on lymph node involvement. Paraaortic lymphadenectomy(PAL) is the ‘Gold Standard’ to asses paraaortic involvement. Positron Emission Tomography ([18]FDG-PET/CT) plays a role in diagnosing retroperitoneal involvement and distant metastases. We aimed to evaluate the contribution of FDG-PET/CT for the staging of LACC.
Methodology From January 2013 to December 2018 all patients diagnosed with LACC (clinical FIGO 2009 >IB2) were included in observational prospective database. All patients underwent a whole-body FDG-PET/CT for primary staging. PAL Surgical approaches were: laparoscopic retroperitoneal (LRP) or robotic transperitoneal (RT). False positive (FP), false negative (FN), negative predictive value (NPV) and positive predictive value (PPV) were analyzed for FDG-PET/CT compared to PAL.
Results 103 patients were included and 9 (8,7%) patients were diagnosed with distant metastases ( FIGO IVB) by FDG-PET/CT and confirmed by biopsy. Therefore, in those 8.7% of patients, the indication of EBRT/CHT was changed to exclusive CHT. 17 patients didn’t underwent PAL due to surgical complexity or poor overall health.
77 patients (74,7%) underwent PAL (32 LRP - 45 RT) without statistically differences in age, BMI, complications, and number of nodes. RT was faster than LRP (106min vs 135min p=00,7).
PPV 57,1%, FP 42,9%, NPV 87,1%, FN 12,9% of PET/CT compared to PAL. In case of negative Pelvic and PA nodes in FDG-PET/CT, the FN was 5,9%. However, FN was 19,4% when Pelvic nodes were + (table 1).
Conclusion This study suggests that FDG-PET/CT is an effective imaging technique to assess lymph node involvement in LACC with good NPV except in positive pelvic lymph nodes with negative paraaortic.
FDG-PET/CT diagnoses almost 10% of unsuspected metastases (FIGO IVB) leading to a change in treatment.
Disclosures The authors have nothing to disclose.