Skip to main content

Advertisement

Log in

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

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Green JA, Kirwan JM, Tierney JF, et al. Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis. Lancet. 2001;358:781–6.

    Article  PubMed  CAS  Google Scholar 

  2. Piver MS, Barlow JJ, Krishnamsetty R. Five-year survival (with no evidence of disease) in patients with biopsy-confirmed aortic node metastasis from cervical carcinoma. Am J Obstet Gynecol. 1981;139:575–8.

    PubMed  CAS  Google Scholar 

  3. Lai CH. Management of recurrent cervical cancer. Chang Gung Med J. 2004;27:711–7.

    PubMed  Google Scholar 

  4. McCullough WM, Nahhas WA. Palliative pelvic exenteration—futility revisited. Gynecol Oncol. 1987;27:97–103.

    Article  PubMed  CAS  Google Scholar 

  5. Marnitz S, Kohler C, Muller M, Behrens K, Hasenbein K, Schneider A. Indications for primary and secondary exenterations in patients with cervical cancer. Gynecol Oncol. 2006;103:1023–30.

    Article  PubMed  Google Scholar 

  6. Scheidler J, Hricak H, Yu KK, Subak L, Segal MR. Radiological evaluation of lymph node metastases in patients with cervical cancer. A meta-analysis. JAMA. 1997;278:1096–101.

    Article  PubMed  CAS  Google Scholar 

  7. Rockall AG, Sohaib SA, Harisinghani MG, et al. Diagnostic performance of nanoparticle-enhanced magnetic resonance imaging in the diagnosis of lymph node metastases in patients with endometrial and cervical cancer. J Clin Oncol. 2005;23:2813–21.

    Article  PubMed  Google Scholar 

  8. Havrilesky LJ, Kulasingam SL, Matchar DB, Myers ER. FDG-PET for management of cervical and ovarian cancer. Gynecol Oncol. 2005;97:183–91.

    Article  PubMed  Google Scholar 

  9. Reinhardt MJ, Ehritt-Braun C, Vogelgesang D, et al. Metastatic lymph nodes in patients with cervical cancer: detection with MR imaging and FDG PET. Radiology. 2001;218:776–82.

    PubMed  CAS  Google Scholar 

  10. Choi HJ, Roh JW, Seo SS, et al. Comparison of the accuracy of magnetic resonance imaging and positron emission tomography/computed tomography in the presurgical detection of lymph node metastases in patients with uterine cervical carcinoma: a prospective study. Cancer. 2006;106:914–22.

    Article  PubMed  Google Scholar 

  11. Ma SY, See LC, Lai CH, et al. Delayed (18)F-FDG PET for detection of paraaortic lymph node metastases in cervical cancer patients. J Nucl Med. 2003;44:1775–83.

    PubMed  Google Scholar 

  12. Querleu D. Laparoscopic paraaortic node sampling in gynecologic oncology: a preliminary experience. Gynecol Oncol. 1993;49:24–9.

    Article  PubMed  CAS  Google Scholar 

  13. Dargent D, Ansquer Y, Mathevet P. Technical development and results of left extraperitoneal laparoscopic paraaortic lymphadenectomy for cervical cancer. Gynecol Oncol. 2000;77:87–92.

    Article  PubMed  CAS  Google Scholar 

  14. Gadducci A, Tana R, Cosio S, Genazzani AR. The serum assay of tumour markers in the prognostic evaluation, treatment monitoring and follow-up of patients with cervical cancer: a review of the literature. Crit Rev Oncol Hematol. 2008;66:10–20.

    Article  PubMed  Google Scholar 

  15. Zanagnolo V, Minig LA, Gadducci A, et al. Surveillance procedures for patients for cervical carcinoma: a review of the literature. Int J Gynecol Cancer. 2009;19:306–13.

    Article  PubMed  Google Scholar 

  16. Buchsbaum HJ. Extrapelvic lymph node metastases in cervical carcinoma. Am J Obstet Gynecol. 1979;133:814–24.

    PubMed  CAS  Google Scholar 

  17. LaPolla JP, Schlaerth JB, Gaddis O, Morrow CP. The influence of surgical staging on the evaluation and treatment of patients with cervical carcinoma. Gynecol Oncol. 1986;24:194–206.

    Article  PubMed  CAS  Google Scholar 

  18. Weiser EB, Bundy BN, Hoskins WJ, et al. Extraperitoneal versus transperitoneal selective paraaortic lymphadenectomy in the pretreatment surgical staging of advanced cervical carcinoma (a Gynecologic Oncology Group study). Gynecol Oncol. 1989;33:283–9.

    Article  PubMed  CAS  Google Scholar 

  19. Holcomb K, Abulafia O, Matthews RP, Gabbur N, Lee YC, Buhl A. The impact of pretreatment staging laparotomy on survival in locally advanced cervical carcinoma. Eur J Gynaecol Oncol. 1999;20:90–3.

    PubMed  CAS  Google Scholar 

  20. Odunsi K, Lele S, Ghamande S, Seago P, Driscoll D. The impact of pre-therapy extraperitoneal surgical staging on the evaluation and treatment of patients with locally advanced cervical cancer. Eur J Gynaecol Oncol. 2001;22:325–330.

    PubMed  CAS  Google Scholar 

  21. Denschlag D, Gabriel B, Mueller-Lantzsch C, et al. Evaluation of patients after extraperitoneal lymph node dissection for cervical cancer. Gynecol Oncol. 2005;96:658–64.

    Article  PubMed  CAS  Google Scholar 

  22. Fine BA, Hempling RE, Piver MS, Baker TR, McAuley M, Driscoll D. Severe radiation morbidity in carcinoma of the cervix: impact of pretherapy surgical staging and previous surgery. Int J Radiat Oncol Biol Phys. 1995;31:717–23.

    Article  PubMed  CAS  Google Scholar 

  23. Recio FO, Piver MS, Hempling RE. Pretreatment transperitoneal laparoscopic staging pelvic and paraaortic lymphadenectomy in large (> or = 5 cm) stage IB2 cervical carcinoma: report of a pilot study. Gynecol Oncol. 1996;63:333–6.

    Article  PubMed  CAS  Google Scholar 

  24. Vidaurreta J, Bermudez A, DiPaola G, Sardi J. Laparoscopic staging in locally advanced cervical carcinoma: a new possible philosophy? Gynecol Oncol. 1999;75:366–371.

    Article  PubMed  CAS  Google Scholar 

  25. Hertel H, Kohler C, Elhawary T, Michels W, Possover M, Schneider A. Laparoscopic staging compared with imaging techniques in the staging of advanced cervical cancer. Gynecol Oncol. 2002;87:46–51.

    Article  PubMed  Google Scholar 

  26. Vergote I, Amant F, Berteloot P, Van Gramberen M. Laparoscopic lower para-aortic staging lymphadenectomy in stage IB2, II, and III cervical cancer. Int J Gynecol Cancer. 2002;12:22–6.

    Article  PubMed  Google Scholar 

  27. Marnitz S, Köhler C, Roth C, Füller J, Hinkelbein W, Schneider A. Is there a benefit of pretreatment laparoscopic transperitoneal surgical staging in patients with advanced cervical cancer? Gynecol Oncol. 2005;99:536–544.

    Article  PubMed  Google Scholar 

  28. Querleu D, Dargent D, Ansquer Y, Leblanc E, Narducci F. Extraperitoneal endosurgical aortic and common iliac dissection in the staging of bulky or advanced cervical carcinomas. Cancer. 2000;88:1883–91.

    Article  PubMed  CAS  Google Scholar 

  29. Lowe MP, Bahador A, Muderspach LI, et al. Feasibility of laparoscopic extraperitoneal surgical staging for locally advanced cervical carcinoma in a gynecologic oncology fellowship training program. J Minim Invasive Gynecol. 2006;13:391–7.

    Article  PubMed  Google Scholar 

  30. Leblanc E, Narducci F, Frumovitz M, et al. Therapeutic value of pretherapeutic extraperitoneal laparoscopic staging of locally advanced cervical carcinoma. Gynecol Oncol. 2007;105:304–11.

    Article  PubMed  Google Scholar 

  31. Gil-Moreno A, Diaz-Feijoo B, Perez-Benavente A, del Campo JM, Xercavins J, Martinez-Palones JM. Impact of extraperitoneal lymphadenectomy on treatment and survival in patients with locally advanced cervical cancer. Gynecol Oncol. 2008;110:S33–5.

    Article  PubMed  Google Scholar 

  32. Lowe MP, Tillmanns T. Outpatient laparoscopic extraperitoneal aortic nodal dissection for locally advanced cervical carcinoma. Gynecol Oncol. 2008;111:S24–8.

    Article  PubMed  Google Scholar 

  33. Michel G, Morice P, Castaigne D, Leblanc M, Rey A, Duvillard P. Lymphatic spread in stage Ib and II cervical carcinoma: anatomy and surgical implications. Obstet Gynecol. 1998;91:360–3.

    Article  PubMed  CAS  Google Scholar 

  34. Singh AK, Grigsby PW, Rader JS, Mutch DG, Powell MA. Cervix carcinoma, concurrent chemoradiotherapy, and salvage of isolated paraaortic lymph node recurrence. Int J Radiat Oncol Biol Phys. 2005;61:450–5.

    Article  PubMed  Google Scholar 

  35. Yeh LS, Hung YC, Shen YY, Kao CH, Lin CC, Lee CC. Detecting para-aortic lymph nodal metastasis by positron emission tomography of 18F-fluorodeoxyglucose in advanced cervical cancer with negative magnetic resonance imaging findings. Oncol Rep. 2002;9:1289–92.

    PubMed  Google Scholar 

  36. Lin WC, Hung YC, Yeh LS, Kao CH, Yen RF, Shen YY. Usefulness of (18)F-fluorodeoxyglucose positron emission tomography to detect para-aortic lymph nodal metastasis in advanced cervical cancer with negative computed tomography findings. Gynecol Oncol. 2003;89:73–6.

    Article  PubMed  Google Scholar 

  37. Roh JW, Seo SS, Lee S, et al. Role of positron emission tomography in pretreatment lymph node staging of uterine cervical cancer: a prospective surgicopathologic correlation study. Eur J Cancer. 2005;41:2086–92.

    Article  PubMed  Google Scholar 

  38. Mortier DG, Stroobants S, Amant F, Neven P, Van Limbergen E, Vergote I. Laparoscopic para-aortic lymphadenectomy and positron emission tomography scan as staging procedures in patients with cervical carcinoma stage IB2-IIIB. Int J Gynecol Cancer. 2008;18:723–9.

    Article  PubMed  CAS  Google Scholar 

  39. Yildirim Y, Sehirali S, Avci ME, et al. Integrated PET/CT for the evaluation of para-aortic nodal metastasis in locally advanced cervical cancer patients with negative conventional CT findings. Gynecol Oncol. 2008;108:154–9.

    Article  PubMed  CAS  Google Scholar 

  40. Kim SK, Kang KW, Roh JW, Sim JS, Lee ES, Park SY. Incidental ovarian 18F-FDG accumulation on PET: correlation with the menstrual cycle. Eur J Nucl Med Mol Imaging. 2005;32:757–63.

    Article  PubMed  CAS  Google Scholar 

  41. Sironi S, Buda A, Picchio M, et al. Lymph node metastasis in patients with clinical early-stage cervical cancer: detection with integrated FDG PET/CT. Radiology. 2006;238:272–9.

    Article  PubMed  Google Scholar 

  42. Kidd EA, Spencer CR, Huettner PC, et al. Cervical cancer histology and tumor differentiation affect 18F-fluorodeoxyglucose uptake. Cancer. 2009;115:3548–54.

    Article  PubMed  Google Scholar 

  43. Tatsumi M, Cohade C, Bristow RE, Wahl RL. Imaging uterine cervical cancer with FDG-PET/CT: direct comparison with PET. Mol Imaging Biol. 2009;11:229–35.

    Article  PubMed  Google Scholar 

  44. Grigsby PW, Singh AK, Siegel BA, Dehdashti F, Rader J, Zoberi I. Lymph node control in cervical cancer. Int J Radiat Oncol Biol Phys. 2004;59:706–12.

    Article  PubMed  Google Scholar 

  45. Tsai CS, Chang TC, Lai CH, et al. Preliminary report of using FDG-PET to detect extrapelvic lesions in cervical cancer patients with enlarged pelvic lymph nodes on MRI/CT. Int J Radiat Oncol Biol Phys. 2004;58:1506–12.

    Article  PubMed  Google Scholar 

  46. Kang S, Seo S, Park S. Occult para-aortic lymph node metastasis after negative positron emission tomography/computed tomography scan. J Clin Oncol. 2008;26:5140.

    Article  PubMed  Google Scholar 

  47. Goff BA, Muntz HG, Paley PJ, Tamimi HK, Koh WJ, Greer BE. Impact of surgical staging in women with locally advanced cervical cancer. Gynecol Oncol. 1999;74:436–42.

    Article  PubMed  CAS  Google Scholar 

  48. Gold MA, Tian C, Whitney CW, Rose PG, Lanciano R. Surgical versus radiographic determination of para-aortic lymph node metastases before chemoradiation for locally advanced cervical carcinoma: a Gynecologic Oncology Group study. Cancer. 2008;112:1954–63.

    Article  PubMed  Google Scholar 

  49. Lai CH, Huang KG, Hong JH, et al. Randomized trial of surgical staging (extraperitoneal or laparoscopic) versus clinical staging in locally advanced cervical cancer. Gynecol Oncol. 2003;89:160–7.

    Article  PubMed  Google Scholar 

  50. Boughanim M, Leboulleux S, Rey A, et al. Histologic results of para-aortic lymphadenectomy in patients treated for stage IB2/II cervical cancer with negative [18F]fluorodeoxyglucose positron emission tomography scans in the para-aortic area. J Clin Oncol. 2008;26:2558–61.

    Article  PubMed  Google Scholar 

  51. Houvenaeghel G, Lelievre L, Rigouard AL, et al. Residual pelvic lymph node involvement after concomitant chemoradiation for locally advanced cervical cancer. Gynecol Oncol. 2006;102:74–9.

    Article  PubMed  Google Scholar 

  52. Occelli B, Narducci F, Lanvin D, et al. De novo adhesions with extraperitoneal endosurgical para-aortic lymphadenectomy versus transperitoneal laparoscopic para-aortic lymphadenectomy: a randomized experimental study. Am J Obstet Gynecol. 2000;183:529–33.

    Article  PubMed  CAS  Google Scholar 

Download references

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).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to E. Leblanc MD.

Additional information

This study was conducted on behalf of French Gynecologic Oncology Group.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-011-1583-9

Keywords

Navigation