Small pelvic lymph node metastases: Evaluation with MR imaging

Roy, Catherine; Bras, Y. Le; Mangold, Leslie A.; Saussine, C.; Tuchmann, C.; Pfleger, D; Jacqmin, Didier

doi:10.1016/s0009-9260(97)80004-9

Cited by 46 publications

(12 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Given that the short-axis diameter of many metastatic LNs may lie within a narrow range of 8-10 mm, even seemingly small 1-mm alterations in size criteria may lead to significant shifts in sensitivity and specificity. Investigators have also explored using the long-axis diameter [11,13] or shape by calculating the L/S ratio [7,11,29] to predict LN status. Our results demonstrating an unsatisfactory diagnostic accuracy for these two criteria (Az, 0.640 and 0.652 for the long-axis diameter and L/S ratio, respectively) indicate that these strategies are limited as well.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Node-by-node correlation between MR and PET/CT in patients with uterine cervical cancer: diffusion-weighted imaging versus size-based criteria on T2WI

et al. 2009

View full text Add to dashboard Cite

The purpose of the study was to perform a node-by-node comparison of an ADC-based diagnosis and various size-based criteria on T2-weighted imaging (T2WI) with regard to their correlation with PET/CT findings in patients with uterine cervical cancer. In 163 patients with 339 pelvic lymph nodes (LNs) with short-axis diameter >5 mm, the minimum apparent diffusion coefficient (ADC), mean ADC, short- and long-axis diameters, and ratio of long- to short-axis diameters (L/S ratio) were compared in PET/CT-positive and -negative LNs. On PET/CT, 118 (35%) LNs in 58 patients were positive. The mean value of minimum and mean ADCs, short- and long-axis diameters, and L/S ratio were different in PET/CT-positive (0.6436 x 10(-3) mm(2)/s, 0.756 x 10(-3) mm(2)/s, 10.3 mm, 13.2 mm, 1.32, respectively) and PET/CT-negative LNs (0.8893 x 10(-3) mm(2)/s, 1.019 x 10(-3) mm(2)/s, 7.4 mm, 11.0 mm, 1.49, respectively) (P < 0.05). The Az value of the minimum ADC (0.864) was greater than those of mean ADC (0.836), short-axis diameter (0.764), long-axis diameter (0.640) and L/S ratio (0.652) (P < 0.05). The sensitivity and accuracy of the minimum ADC (86%, 82%) were greater than those of the short-axis diameter (55%, 74%), long-axis diameter (73%, 58%) and L/S ratio (52%, 66%) (P < 0.05). ADC showed superior correlation with PET/CT compared with conventional size-based criteria on T2WI.

show abstract

Section: Discussionmentioning

confidence: 99%

“…greater than 10 mm across the short-axis diameter. However, the diagnostic performance has not been satisfactory, as the reported sensitivities have been widely variable, ranging from 33% to 72% [5][6][7][8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Node-by-node correlation between MR and PET/CT in patients with uterine cervical cancer: diffusion-weighted imaging versus size-based criteria on T2WI

et al. 2009

View full text Add to dashboard Cite

show abstract

“…We characterized lymph nodes by size and USPIO enhancement. We measured size on T1-weighted SE images to minimize interference with susceptibility effects (metastasis=short axis diameter >10 mm [10,11]). We analyzed nodal USPIO uptake primarily on the gradient-echo sequence.…”

Section: Methodsmentioning

confidence: 99%

“…However, like computed tomography (CT), it is less suited for assessing pelvic lymph node status. The major malignancy marker is a short-axis diameter of less than 1 cm [10,11]. However, false-negative results for normal-sized malignant nodes and the impossibility of differentiating between similarly hyperplastic metastatic vs non-metastatic nodes impair staging performance [12].…”

Section: Introductionmentioning

confidence: 99%

USPIO-enhanced MRI for preoperative staging of gynecological pelvic tumors: preliminary results

Keller

Michel

Fröhlich³

et al. 2004

European Radiology

View full text Add to dashboard Cite

The aim of this study was to assess nodal enhancement with ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI) during preoperative staging of gynecological pelvic tumors within the same imaging session for the primary tumor. Pelvic MRI was performed 18-28 h after intravenous infusion of USPIO (Combidex/Sinerem, 2.6 mg Fe/kg body weight) in 13 women (mean age 51 years) scheduled for surgery for biopsy proven ( n=11) or clinically suspected ( n=2) uterine carcinoma. Axial T1-weighted spin-echo (SE), T2-weighted fast SE (FSE; with fat saturation), fast spoiled gradient-recalled (FSPGR) echo, sagittal and oblique T2-weighted FSE sequences were acquired on a 1.5-T system. Lymph nodes were prospectively staged using standard criteria, i.e., size and shape, as well as USPIO enhancement. Results were correlated with histology findings. MRI correctly staged all primary uterine tumors. In one case, the preoperative diagnosis of stage IV switched the therapeutic approach to radiochemotherapy. Ninety-one (86 benign, 5 malignant) of the histologically characterized nodes could be correlated with their MRI counterparts. One node was false positive; three micrometastases greater than 5 mm and one 5-mm metastasis were missed. On a nodal basis, the sensitivity score was 0.33 and the specificity score, 0.99. On a patient basis, the sensitivity score was 0.25 and the specificity score, 0.80. Our preliminary results indicate that USPIO-enhanced pelvic MRI for preoperative nodal assessment is feasible within one imaging session for primary tumors and that it has a high specificity. However, the low sensitivity in the present study is a limitation for the clinical application of this technique.

show abstract

“…It is not a sensitive means of detecting micrometastatic nodes, but gross involvement can be identified. 15 Formal staging of endometrial cancer, however, as per the Federation International de Gynaecologie et Obstetrique (FIGO) classification, is based on surgical staging and histopathology (Table 1). Full staging requires a pelvic and para-aortic node dissection, but in the absence of obvious pelvic node involvement and palpable para aortic nodes, the latter need not be removed.…”

Section: Role Of Imagingmentioning

confidence: 99%

Magnetic Resonance Imaging of Uterine Malignancies

Whitten¹,

deSouza²

2006

Topics in Magnetic Resonance Imaging

View full text Add to dashboard Cite

Magnetic Resonance Imaging (MRI) is the criterion standard in the assessment and staging of uterine cancer because of the high tissue contrast between glandular lining and inner and outer muscle layers of the uterine corpus and cervix on T2-weighted scans. It is also an essential tool in monitoring treatment response and in assessing disease recurrence in these patients. The key to a successful examination lies in good patient preparation, use of antiperistaltic agents, and a meticulous scanning technique. Endometrial carcinomas are the most common uterine malignancy, occurring in a primarily postmenopausal population. Dynamic contrast-enhanced scans may be required in addition to T2-weighted images to assess the presence of myometrial invasion in this age group. Cervical cancers occur in a younger population and are readily assessed with T2-weighted imaging. Use of an endovaginal receiver coil allows high spatial resolution imaging of the cervix, which is particularly useful when assessing patients for fertility-sparing procedures such as trachelectomy. Uterine sarcomas are 1% to 3% of all uterine malignancies and usually arise from a mixture of homologous and heterologous elements. Rarely, lymphoma, small cell carcinoma and metastatic deposits involve the uterus. This review summarizes the optimal scanning techniques for demonstrating uterine malignancy and discusses the role of imaging and the MRI appearances of uterine tumors.

show abstract

Small pelvic lymph node metastases: Evaluation with MR imaging

Cited by 46 publications

References 24 publications

Node-by-node correlation between MR and PET/CT in patients with uterine cervical cancer: diffusion-weighted imaging versus size-based criteria on T2WI

Node-by-node correlation between MR and PET/CT in patients with uterine cervical cancer: diffusion-weighted imaging versus size-based criteria on T2WI

USPIO-enhanced MRI for preoperative staging of gynecological pelvic tumors: preliminary results

Magnetic Resonance Imaging of Uterine Malignancies

Contact Info

Product

Resources

About