Value of imaging study in predicting pelvic lymph node metastases of uterine cervical cancer

Abstract

PurposeTo evaluate the diagnostic accuracy of computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT) in predicting pelvic lymph node (LN) metastases in patients with cervical cancer.Materials and MethodsFrom January 2009 to March 2015, 114 patients with FIGO stage IA1-IIB uterine cervical cancer who underwent hysterectomy with pelvic lymphadenectomy and took CT, MRI, and PET/CT before surgery were enrolled in this study. The criteria for LN metastases were a LN diameter ≥1.0 cm and/or the presence of central necrosis on CT, a LN diameter ≥1.0 cm on MRI, and a focally increased FDG uptake on PET/CT. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for pelvic LN metastases were estimated.ResultsThe sensitivity, specificity, PPV, NPV, and accuracy for detection of pelvic LN metastases were 51.4%, 85.9%, 41.3%, 90.1%, and 80.3% for CT; 24.3%, 96.3%, 56.3%, 86.8%, and 84.6% for MRI; and 48.6%, 89.5%, 47.4%, 90.0%, and 82.9% for PET/CT, respectively. The sensitivity of PET/CT and CT was higher than that of MRI (p=0.004 and p= 0.013, respectively). The specificity of MRI was higher than those of PET/CT and CT (p=0.002 and p=0.001, respectively). The difference of specificity between PET/CT and CT was not statistically significant (p=0.167).ConclusionThese results indicate that preoperative CT, MRI, and PET/CT showed low to moderate sensitivity and PPV, and moderate to high specificity, NPV, and accuracy. More efforts are necessary to improve sensitivity of imaging modalities in order to predict pelvic LN metastases.

The feasibility of 18F-FDG PET/CT for predicting pathologic risk status in early-stage uterine cervical squamous cancer

“…Among these PRFs, PET/CT is most commonly used in the diagnosis of pelvic lymph node metastasis, which is the most important influencing factor for survival and could increase recurrence to 25-30% [4]. However, the diagnostic performances of PET/CT scans are variable, with the sensitivity ranging from 8.3 to 82% in early uterine cervical cancer [9][10][11][12][13]. The unsatisfactory and inconsistent result may be that the metastasis of lymph nodes is not an independent behaviour but is affected by a variety of clinicopathological factors, including tumour differentiation, invasion depth of stroma, involvement of the parametrium, and so on [14].…”

“…18 F-2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ( 18 F-FDG PET/ CT) is an important molecular imaging modality that has been widely used for the diagnosis, staging, response assessment, recurrence detection, and survival analysis of uterine cervical cancer [8]. Among these PRFs, PET/CT is the most commonly used for diagnosing pelvic lymph node metastasis, and the values are variable, with the sensitivity ranging from 8.3 to 82% in early uterine cervical cancer [9][10][11][12][13]. The reason for this inconsistent result may be that lymph node metastasis is not an independent behaviour but is affected by a variety of clinicopathological factors, including tumour differentiation, invasion depth of stroma, involvement of the parametrium, and so on [14].…”

Long non-coding RNA CRNDE may be associated with poor prognosis by promoting proliferation and inhibiting apoptosis of cervical cancer cells through targeting PI3K/AKT

“…The gynecological oncology was divided into different stages in accordance with the specific pathological features. The standards for stage division were enacted by the International Federation of Gynecology and Obstetrics (FIGO) [20]. According to the specific biological features, patient samples used in this study were divided into stage Ib-IIa and stage IIb~IIIa groups.…”

Is 18F-FDG PET/CT an Accurate Way to Detect Lymph Node Metastasis in Colorectal Cancer: A Systematic Review and Meta-Analysis

“…Accurate diagnosis of LN metastasis at early stage may improve diagnosis and prompt the initiation of second-line treatment in patients with rectal cancer [4]. Conventional imaging techniques play an important role in the detection of malignant lymph node metastases [7,8]. e goals of preoperative imaging are to determine the size of the primary tumor, adjacent organs involved, distant metastases or concurrent malignancy.…”