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  • Impact of tumor histology on detection of pelvic and para-aortic nodal metastasis with 18F-fluorodeoxyglucose–positron emission tomography in stage IB cervical cancer

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Original Article
Impact of tumor histology on detection of pelvic and para-aortic nodal metastasis with 18F-fluorodeoxyglucose–positron emission tomography in stage IB cervical cancer
  1. Alexander J Lin1,
  2. Jason D Wright2,
  3. Farrokh Dehdashti3,4,
  4. Barry A Siegel4,5,
  5. Stephanie Markovina1,4,
  6. Julie Schwarz1,4,
  7. Premal H Thaker3,4,
  8. David G Mutch3,4,
  9. Matthew A Powell3,4 and
  10. Perry W Grigsby1,4,5
  1. 1Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri, USA
  2. 2Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York, USA
  3. 3Division of Gynecology Oncology Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri, USA
  4. 4Alvin J Cancer Center, Alvin J Siteman Cancer Center Washington University School of Medicine, St Louis, Missouri, USA
  5. 5Division of Nuclear Medicine, Mallinckrodt Institute of Radiology Washington University School of Medicine, St Louis, Missouri, USA
  1. Correspondence to Dr Perry W Grigsby; pgrigsby{at}wustl.edu

Abstract

Objective 18F-fluorodeoxyglucose–positron emission tomography (FDG-PET) detection of metastatic nodal disease is useful for guiding cervical cancer treatment but the impact of tumor histology is unknown. This study reports the detection of FDG avid pelvic and para-aortic lymph nodes in patients with early stage cervical cancer with squamous carcinoma and adenocarcinoma tumor histology.

Methods Patients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB1-2 cervical cancer who underwent pre-surgical FDG-PET between March 1999 and February 2018 were identified in a tertiary academic center database. All patients had radical hysterectomy with pelvic and para-aortic lymph node dissection. Detection of pelvic and para-aortic lymph nodes by FDG-PET versus surgical dissection was compared. FDG-PET sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined and stratified by tumor histology.

Results We identified 212 patients with early stage cervical cancer (84% FIGO IB1, 16% IB2) who underwent pre-surgical FDG-PET; 137 (65%) patients had squamous carcinoma and 75 (35%) patients had adenocarcinoma. PET/computed tomography was performed in 189 (89%) patients and 23 (11%) had PET only. Surgical dissection revealed positive pelvic and para-aortic lymph nodes in 25% and 3.3% of patients, respectively. For squamous carcinoma, sensitivity, specificity, PPV, and NPV of FDG-PET for pelvic nodal metastasis were 44%, 99%, 95%, and 78%, respectively. For adenocarcinoma, the corresponding results for pelvic nodal metastasis were 25%, 99%, 67%, and 92%, respectively. The overall values for sensitivity, specificity, PPV, and NPV of FDG-PET for para-aortic nodal metastasis were 29%, 99%, 67%, and 98%, respectively.

Discussion Pelvic nodal metastasis was less likely to be detected by FDG-PET in patients with early stage adenocarcinoma than with squamous carcinoma.

  • cervical cancer
  • squamous carcinoma
  • adenocarcinoma
  • positron emission tomography
  • lymph nodes

https://doi.org/10.1136/ijgc-2019-000528

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    Footnotes

    • Contributors AJL: data curation, methodology, formal analysis, and writing the original draft. JDW, FD, BS, SM, JS, PT, DM, and MP: review and editing. PG: conceptualization, review, and editing.

    • Funding PG is supported by NIH R21 CA223799-01. JS is supported by NIH R01 CA181745-01. SM is supported by NIH K08 CA237822. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.