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Purpose-To compare MRI, CT, clinical exam and histopathological analysis for predicting lymph node involvement in women with cervical carcinoma, verified by lymphadenectomy.Methods-A 25-center ACRIN/GOG study enrolled 208 patients with biopsy-proven invasive cervical cancer for MRI and CT prior to attempted curative radical hysterectomy. Each imaging study was interpreted prospectively by one onsite radiologist, and retrospectively by 4 independent offsite radiologists, all blinded to surgical, histopathological and other imaging findings. Likelihood of parametrial and uterine body involvement was rated on a 5-point scale. Tumor size measurements were attempted in 3 axes. Association with histologic lymph node involvement, scored as absent, pelvic only and common iliac or paraaortic, was evaluated using Cochran-Mantel Haenszel statistics, univariate and multivariate logistic regression, generalized estimating equations, accuracy statistics and ROC analysis.Results-Lymphatic metastases were found in 34% of women; 13% had common iliac nodal metastases, and 9% had paraortic nodal metastases. Based on the retrospective multi-observer rereads, average AUC for predicting histologic lymph node involvement between MRI and CT for tumor size were higher for MRI versus CT, although formal statistic comparisons could not be NIH Public Access Author ManuscriptGynecol Oncol. Author manuscript; available in PMC 2010 January 1. Published in final edited form as:Gynecol Oncol. conducted. Multivariate analysis showed improved model fit incorporating predictors from MRI, but not CT, over and above the initial clinical and biopsy predictors, although the increase in discriminatory ability was not statistically significant.Conclusion-MRI findings may help predict the presence of histologic lymph node involvement in women with early invasive cervical carcinoma, thus providing important prognostic information.In women with cervical carcinoma that involves their lymph nodes, surgery alone is not sufficient treatment, and pelvic irradiation will not be curative if the tumor has metastasized to lymph nodes above the irradiated field. Unfortunately, even FDG PET/CT is not sensitive for detecting cervical carcinoma lymphatic metastases that have short axis diameter less than 5 mm. METHODSEach imaging site was required to have a proven record of 20 surgical cases of cervical cancer per year, 1.5 T MRI and helical CT equipment, and an adequately qualified and committed radiologist, gynecologic oncologist, and pathologist. All institutions had study-specific institutional review board (IRB) approval. Between March 2000 and November 2002, 208 participants were accrued from 25 academic and community health centers. Methodology is described in further detail in earlier publications from this trial. [17,18] ParticipantsConsecutive participants with untreated biopsy-confirmed cervical cancer who were scheduled for curative hysterectomy based on pre-enrollment FIGO assessment were asked to participate. Imaging findings suspicious for met...
Purpose-To compare MRI, CT, clinical exam and histopathological analysis for predicting lymph node involvement in women with cervical carcinoma, verified by lymphadenectomy.Methods-A 25-center ACRIN/GOG study enrolled 208 patients with biopsy-proven invasive cervical cancer for MRI and CT prior to attempted curative radical hysterectomy. Each imaging study was interpreted prospectively by one onsite radiologist, and retrospectively by 4 independent offsite radiologists, all blinded to surgical, histopathological and other imaging findings. Likelihood of parametrial and uterine body involvement was rated on a 5-point scale. Tumor size measurements were attempted in 3 axes. Association with histologic lymph node involvement, scored as absent, pelvic only and common iliac or paraaortic, was evaluated using Cochran-Mantel Haenszel statistics, univariate and multivariate logistic regression, generalized estimating equations, accuracy statistics and ROC analysis.Results-Lymphatic metastases were found in 34% of women; 13% had common iliac nodal metastases, and 9% had paraortic nodal metastases. Based on the retrospective multi-observer rereads, average AUC for predicting histologic lymph node involvement between MRI and CT for tumor size were higher for MRI versus CT, although formal statistic comparisons could not be NIH Public Access Author ManuscriptGynecol Oncol. Author manuscript; available in PMC 2010 January 1. Published in final edited form as:Gynecol Oncol. conducted. Multivariate analysis showed improved model fit incorporating predictors from MRI, but not CT, over and above the initial clinical and biopsy predictors, although the increase in discriminatory ability was not statistically significant.Conclusion-MRI findings may help predict the presence of histologic lymph node involvement in women with early invasive cervical carcinoma, thus providing important prognostic information.In women with cervical carcinoma that involves their lymph nodes, surgery alone is not sufficient treatment, and pelvic irradiation will not be curative if the tumor has metastasized to lymph nodes above the irradiated field. Unfortunately, even FDG PET/CT is not sensitive for detecting cervical carcinoma lymphatic metastases that have short axis diameter less than 5 mm. METHODSEach imaging site was required to have a proven record of 20 surgical cases of cervical cancer per year, 1.5 T MRI and helical CT equipment, and an adequately qualified and committed radiologist, gynecologic oncologist, and pathologist. All institutions had study-specific institutional review board (IRB) approval. Between March 2000 and November 2002, 208 participants were accrued from 25 academic and community health centers. Methodology is described in further detail in earlier publications from this trial. [17,18] ParticipantsConsecutive participants with untreated biopsy-confirmed cervical cancer who were scheduled for curative hysterectomy based on pre-enrollment FIGO assessment were asked to participate. Imaging findings suspicious for met...
In patients with cervical cancer, MRI is superior to CT and clinical examination for evaluating uterine body involvement and measuring tumor size, but no method was accurate for evaluating cervical stroma.
Positron emission tomography (PET) and computed tomography (CT) have evolved as a pivotal diagnostic modality in the field of oncology. With its increasing application in staging and ready availability, it becomes imperative for committed radiation oncologists to possess a complete analysis and understanding of integration of molecular imaging, which can be helpful for radiation planning, while also acknowledging its possible limitations and challenges. A significant obstacle lies in the synthesis and design of tumor-specific bmolecules for diagnosing and treating cancer. The utilization of radiation in medical biochemistry and biotechnology, encompassing diagnosis, therapy, and control of biological systems, is encapsulated under the umbrella term “nuclear medicine.” Notably, the application of various radioisotopes in pharmaceutics has garnered significant attention, particularly in the realm of delivery systems for drugs, DNA, and imaging agents. The present article provides a comprehensive review of use of novel techniques PET and CT with major positron-emitting radiopharmaceuticals currently in progress or utilized in clinical practice with their integration into imaging and radiation therapy.
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