Diagnostic Value of Magnetic Resonance Imaging (MRI), Computed Tomography (CT) and Positron Emission Tomography (PET) in the Detection of Lymph Node Metastases in Gynaecologic Cancers

Abstract

Background: A factor that affects the staging of gynaecological cancers is the status of adenopathy’s and imaging tests are a fundamental part of staging. Primary Objective: To assess the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) in the detection of pathological lymphadenopathies in gynaecological cancers of magnetic resonance imaging (MRI), computerized axial tomography (CAT) and positrons emission tomography (PET). Study Hypothesis: Imaging tests are not as valid as lymphadenectomy for the diagnosis of pathological lymphadenopathies. Trial Design: Retrospective study performed in the gynaecological oncology unit of a tertiary hospital. Major Inclusion/Exclusion Criteria: Patients diagnosed with genital cancer (endometrium, ovary or cervix) in the period between January 1, 2014 and December 31, 2018, who meet the following inclusion criteria: (i) have requested a diagnostic test of image (RNM, CT or PET-CT) prior to undergoing surgery; (ii) have undergone surgery for the treatment of cancer and (iii) have undergone lymphadenectomy, pelvic and / or para-aortic, during surgery. Primary Endpoint: Correlation between the imaging tests and the anatomopathological result of the lymph node biopsies. Sample Size: 219 patients who underwent pelvic, para-aortic lymphadenectomy or both due to cancer of the endometrium, ovary or cervix, and at least one imaging test prior to surgery. Results: In our study, PET presents the highest sensitivity (42%) of the diagnostic tests evaluated, the TAC the highest specificity (95%) and the highest PPV (77%) and the MRI the highest NPV (76%). Conclusions: The diagnostic value of imaging tests in the detection of lymph node metastases in gynaecological cancers is limited.