Incidence of Lymph Node Metastases in Women With Low-Risk Early Cervical Cancer (&lt;2 cm) Without Lymph-Vascular Invasion

Minig, Lucas; Fagotti, Anna; Scambia, Giovanni; Salvo, Gloria; Patrono, María Guadalupe; Haidopoulos, Dimitrios; Zapardiel, Ignacio; Domingo, Santiago; Sotiropoulou, Maria; Chisholm, Gary B.; Ramírez, Pedro T.

doi:10.1097/igc.0000000000001236

Cited by 13 publications

(6 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The present data indicate that the low sensitivity of [ 18 F]FDG PET/MRI for G2 LNM might rather be due to smaller size, low SUV and discreet [ 18 F]FDG kinetics than to their hitherto often assumed lower prevalence. In fact, LNM prevalence in G2 was not signi cantly different from that in G3 tumors using ultra-staging as the golden standard [25]. This nding is of high clinical relevance, as the sensitivity of visual assessment of N-status in G2 tumors -even among experienced experts in hybrid imaging-drops below a level that would justify use of [ 18 F]FDG PET as an N-staging method.…”

Section: Impact Of Tumor Gradementioning

confidence: 81%

Multiparametric dual-time-point [18F]FDG-PET/MRI for lymph node staging in patients with untreated FIGO I/II cervical carcinoma

Weissinger¹,

Kommoss²,

Jacoby

et al. 2022

Preprint

View full text Add to dashboard Cite

Purpose:[18F]FDG PET/MRI comes with limited sensitivity for initial detection of lymph node metastases (LNM) in early stage cervical carcinoma. Therefore, the aim of this prospective study was to investigate the additional value of multiparametric dual-time-point PET/MRI and to asses potential influencing factors for LNM detection.Methods: 63 patients underwent whole-body dual-time-point [18F]FDG-PET/MRI ≈60+90min p.i. (Biograph mMR®, Siemens Healthineers). 251 LN were evaluated visually by nuclear medicine and radiology expert, quantified multiparametrically and were correlated with histology. Multiparametric analysis was performed using a logistic regression-based malignancy score (MS).Results:Overall prevalence of LNM was 17.1% and dependent on tumor grade (Gx 1/6, G1:0/19, G2:18/106, G3:24/120). Grading of the primary tumor (G2/G3) had a significant impact on visual detection (sens: 8.3%/31%).Best single parameter for LNM detection was SUVavg, however with a significant loss of discriminatory power in G2 vs. G3 tumors (AUC: 0.673/ 0.901). For multiparametric analysis, the independent predictors “SUVavg, ∆SUVpeak (60 to 90 min p.i.), LN sphericity, ADC and histologic grade” were included in the MS. Application of the MS enhanced AUCs especially in G2 tumors (AUC: G2:0.769; G3:0.877) and improved accuracy for single LNM from 34.5% to 55.5% compared to the best univariate parameter SUVavg.Equated to the expert consensus, use of the malignancy score increased overall sensitivity from 31.0% to 79.3% (Youden optimum) with a moderate decrease in specificity from 98.3% to 75.6%.Conclusion:Low histologic grad (G2 vs. G3) hampers visual detectability of LNM in [18F]FDG-PET/MRI. Multiparametric evaluation of dual-time-point PET/MRI has the potential to improve accuracy compared to visual interpretation and enables sufficient N-staging also in G2 tumors.Trial registration:DRKS00014346. Registered April 4, 2018 - retrospectively registered,https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014346

show abstract

Section: Impact Of Tumor Gradementioning

confidence: 81%

Multiparametric dual-time-point [18F]FDG-PET/MRI for lymph node staging in patients with untreated FIGO I/II cervical carcinoma

Weissinger¹,

Kommoss²,

Jacoby

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…In several tumor entities, LVI has been shown to correlate with LNMs and with prognoses of patients ( 13 – 18 ). Similar data are available for PTC ( 6 , 19 – 24 ).…”

Section: Discussionmentioning

confidence: 99%

“…Even its documented absence (L0) might play some predictive role: a multicenter retrospective analysis found that no LNMs were identified in women with low-risk cervical cancer and no LVI. L0 was suggested as a possible argument for omitting prophylactic lymphadenectomy in these patients (18). Although there is some evidence that LVI in PTC correlates with LNMs (19)(20)(21)(22) and with outcomes of patients (6,23,24), LVI does not play any concrete role in clinical decision-making.…”

Section: Introductionmentioning

confidence: 99%

Lymphatic Vessel Invasion in Routine Pathology Reports of Papillary Thyroid Cancer

et al. 2022

View full text Add to dashboard Cite

PurposeIt is not mandatory to report lymphatic vessel invasion in pathology reports of papillary thyroid cancer (PTC) according to the current Union for International Cancer Control (UICC) TNM (tumor, nodes, and metastases) classification. However, there is some evidence for its correlation with lymph node metastasis (LNM) and prognosis. The aim of this study was to explore the clinical implication of lymphatic vessel invasion documentation of PTC because pathology reports play a pivotal role in postsurgical clinical decision-making in endocrine tumor boards.MethodsPatients undergoing postoperative radioiodine treatment for PTC at the University Hospital of Cologne, Germany between December 2015 and March 2020 were identified. Pathology reports were screened for documentation of lymphatic vessel invasion. Demographics and clinicopathologic data of patients documented, including lymphatic vessel invasion and lymph nodal involvement were analyzed.ResultsA total of 578 patients were identified and included. Lymphatic vessel invasion was reported in pathology reports of 366 (63.3%) and omitted in 112 (36.7%) patients. Positive lymphatic vessel invasion (L1) was diagnosed in 67 (18.3%) of 366 patients and was documented as absent (L0) in 299 (81.7%) patients. Lymph nodal (N) status was positive (N+) in 126 (45.6%) and negative (N0) in 150 (54.3%) of these patients. In 54 (80.6%) L1 cases N+ status and in 137 (65.6%) L0 cases N0 status was diagnosed. In 13 (19.4%) cases with L1 status, there were no LNMs (L1 N0). In total, 72 (34.4%) patients had LNM despite L0 status (L0 N+). The sensitivity and specificity of LVI reporting for LNM were 0.42 and 0.91, respectively.ConclusionIn routine pathology reports of PTC used for indication to postoperative radioiodine treatment by a German endocrine tumor board, lymphatic vessel invasion was found to be reported inconsistently and mostly as L0. L1 diagnoses, however, reliably correlated with reported LNM and might, thus, be relevant for clinical decision-making. For this reason, we advocate for standardized pathologic reassessment of lymphatic vessel invasion, in particular for cases where lymph nodes are not included in the pathologic specimen and if L0 is documented.

show abstract

“…The present data indicate that the low sensitivity of [ 18 F]FDG PET/MRI for G2 LNM might rather be due to smaller size, low SUV, and discreet [ 18 F]FDG kinetics compared with their hitherto often assumed lower prevalence. In fact, LNM prevalence in G2 was not significantly different from that in G3 tumors using ultrastaging as the gold standard [ 26 ]. This finding is of high clinical relevance, as a solely visual assessment of [ 18 F]FDG PET comes with insufficient sensitivity for N-staging in G2 tumors.…”

Section: Discussionmentioning

confidence: 99%

Multiparametric Dual-Time-Point [18F]FDG PET/MRI for Lymph Node Staging in Patients with Untreated FIGO I/II Cervical Carcinoma

Weissinger

Kommoss²,

Jacoby

et al. 2022

JCM

View full text Add to dashboard Cite

[18F]FDG PET/MRI was shown to have limited sensitivity for N-staging in FIGO I/II cervical carcinoma. Therefore, this prospective study aimed to investigate the additional value of multiparametric dual-time-point PET/MRI and to assess potential influencing factors for lymph node metastasis (LNM) detection. A total of 63 patients underwent whole-body dual-time-point [18F]FDG PET/MRI 60 + 90 min p.i., and 251 LN were evaluated visually, quantified multiparametrically, and correlated with histology. Grading of the primary tumor (G2/G3) had a significant impact on visual detection (sens: 8.3%/31%). The best single parameter for LNM detection was SUVavg, however, with a significant loss of discriminatory power in G2 vs. G3 tumors (AUC: 0.673/0.901). The independent predictors SUVavg, ∆SUVpeak, LN sphericity, ADC, and histologic grade were included in the logistic-regression-based malignancy score (MS) for multiparametric analysis. Application of MS enhanced AUCs, especially in G2 tumors (AUC: G2:0.769; G3:0.877) and improved the accuracy for single LNM from 34.5% to 55.5% compared with the best univariate parameter SUVavg. Compared with visual analysis, the use of the malignancy score increased the overall sensitivity from 31.0% to 79.3% (Youden optimum) with a moderate decrease in specificity from 98.3% to 75.6%. These findings indicate that multiparametric evaluation of dual-time-point PET/MRI has the potential to improve accuracy compared with visual interpretation and enables sufficient N-staging also in G2 cervical carcinoma.

show abstract

Incidence of Lymph Node Metastases in Women With Low-Risk Early Cervical Cancer (<2 cm) Without Lymph-Vascular Invasion

Cited by 13 publications

References 28 publications

Multiparametric dual-time-point [18F]FDG-PET/MRI for lymph node staging in patients with untreated FIGO I/II cervical carcinoma

Multiparametric dual-time-point [18F]FDG-PET/MRI for lymph node staging in patients with untreated FIGO I/II cervical carcinoma

Lymphatic Vessel Invasion in Routine Pathology Reports of Papillary Thyroid Cancer

Multiparametric Dual-Time-Point [18F]FDG PET/MRI for Lymph Node Staging in Patients with Untreated FIGO I/II Cervical Carcinoma

Contact Info

Product

Resources

About