Abstract
Purpose
Patients with locally advanced cervical cancer (LACC) are usually treated with concurrent chemoradiotherapy. Extended-field chemoradiotherapy is indicated in case of para-aortic node involvement at initial assessment. 18-Fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (18-FDG PET/CT) is currently considered to be the most accurate method of detection of node or distant metastases. The goal of this study was to evaluate the accuracy of PET at detecting para-aortic lymph node metastases in LACC patients with a negative morphological imaging.
Methods
Patients from five French institutions with LACC and both negative morphologic (magnetic resonance imaging, CT scan) and functional (PET or PET/CT) findings at the para-aortic level and distantly were submitted to a systematic infrarenal para-aortic node dissection either by laparoscopy or laparotomy. On the basis of pathological results, sensitivity, specificity, and positive and negative predictive values of PET/CT were assessed for para-aortic lymph node involvement.
Results
A total of 125 LACC patients (stage IB2–IVA disease with two local recurrences) fulfilled the inclusion criteria. All had an ilio-infrarenal para-aortic lymphadenectomy, either by laparoscopy (n = 117) or laparotomy (n = 8). Twenty-one patients (16.8%) had pathologically proven para-aortic metastases. Among them, 14 (66.7%) had negative PET/CT. Overall morbidity of surgery was 7.2%. All but one of the complications were mild and did not delay chemoradiotherapy. Sensitivity, specificity, and positive and negative predictive value of the PET/CT were 33.3, 94.2, 53.8, and 87.5%, respectively, for the detection of microscopic lymph node metastases.
Conclusions
Laparoscopic staging surgery seems warranted in LACC patients with negative PET scan who are candidates for definitive concurrent chemoradiotherapy or exenteration.
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Acknowledgment
Statistician: Charles Fournier (Lille). Pathologists: Marie Christine Baranzelli (Lille), Pierre Duvillard (Villejuif), Marie Aude Frère-Belda (Paris, Toulouse), Jocelyne Jacquemier (Marseille). Radiother`apists: B. Castelain, P. Nickers (Lille), C. Haie Meder (Villejuif), Mireille Delannes (Toulouse), Bernadette Dessart-Diana (Paris), Mathieu Minsat (Marseille). Medical oncologists: Annick Chevalier, Anne Lesoin, Edith Vanlerenberghe (Lille), Patricia Pautier, Catherine Lhomme (Villejuif), Laurence Gladieff (Toulouse), Maria Cappiello (Marseille). Residents who collected the data: Marie Bannier (Marseille), Audrey Peirera, Malik Boukerrou (Lille), Anne Froute (Toulouse), Mathieu Boughanim (Villejuif), Sherazade Bensaid (Paris).
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This study was conducted on behalf of French Gynecologic Oncology Group.
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Leblanc, E., Gauthier, H., Querleu, D. et al. Accuracy of 18-Fluoro-2-deoxy-d-glucose Positron Emission Tomography in the Pretherapeutic Detection of Occult Para-aortic Node Involvement in Patients with a Locally Advanced Cervical Carcinoma. Ann Surg Oncol 18, 2302–2309 (2011). https://doi.org/10.1245/s10434-011-1583-9
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DOI: https://doi.org/10.1245/s10434-011-1583-9