Diagnostic performance of ultrasonography in pre-operative assessment of lymph nodes in patients with cervical cancer.

Autor:	Fruhauf F; Department of Gynaecology, Obstetrics, and Neonatology, Gynaecologic Oncology Center, General University Hospital and 1st Faculty of Charles University, Prague, Czech Republic filip.fruhauf@vfn.cz., Cibula D; Department of Gynaecology, Obstetrics, and Neonatology, Gynaecologic Oncology Center, General University Hospital and 1st Faculty of Charles University, Prague, Czech Republic., Kocian R; Department of Gynaecology, Obstetrics, and Neonatology, Gynaecologic Oncology Center, General University Hospital and 1st Faculty of Charles University, Prague, Czech Republic., Zikan M; Department of Gynaecology and Obstetrics, Bulovka University Hospital and 1st Faculty of Charles University, Prague, Czech Republic., Dundr P; Institute of Pathology, General University Hospital and 1st Faculty of Charles University, Prague, Czech Republic., Jarkovsky J; Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic., Fischerova D; Department of Gynaecology, Obstetrics, and Neonatology, Gynaecologic Oncology Center, General University Hospital and 1st Faculty of Charles University, Prague, Czech Republic.
Jazyk:	angličtina
Zdroj:	International journal of gynecological cancer : official journal of the International Gynecological Cancer Society [Int J Gynecol Cancer] 2024 Jul 01; Vol. 34 (7), pp. 985-992. Date of Electronic Publication: 2024 Jul 01.
DOI:	10.1136/ijgc-2024-005341
Abstrakt:	Objectives: To assess the diagnostic performance of ultrasonography in pre-operative assessment of lymph nodes in patients with cervical cancer, to compare the outcomes for pelvic and para-aortic regions, and to detect macrometastases and micrometastases separately. Methods: Patients were retrospectively included if they met the following inclusion criteria: pathologically verified cervical cancer; ultrasonography performed by one of four experienced sonographers; surgical lymph node staging, at least in the pelvic region-sentinel lymph node biopsy or systematic pelvic lymphadenectomy or debulking. The final pathological examination was the reference standard. Results: 390 patients met the inclusion criteria between 2009 and 2019. Pelvic node macrometastases (≥2 mm) were confirmed in 54 patients (13.8%), and micrometastases (≥0.2 mm and <2 mm) in another 21 patients (5.4%). Ultrasonography had sensitivity 72.2%, specificity 94.0%, and area under the curve (AUC) 0.831 to detect pelvic macrometastases, while sensitivity 53.3%, specificity 94.0%, and AUC 0.737 to detect both pelvic macrometastases and micrometastases (pN1). Ultrasonography failed to detect pelvic micrometastases, with sensitivity 19.2%, specificity 85.2%, and AUC 0.522. There was no significant impact of body mass index on diagnostic accuracy. Metastases in para-aortic nodes (macrometastases only) were confirmed in 16 of 71 patients who underwent para-aortic lymphadenectomy. Ultrasonography yielded sensitivity 56.3%, specificity 98.2%, and AUC 0.772 to identify para-aortic node macrometastases. Conclusion: Ultrasonography performed by an experienced sonographer can be considered a sufficient diagnostic tool for pre-operative assessment of lymph nodes in patients with cervical cancer, showing similar diagnostic accuracy in detection of pelvic macrometastases as reported for other imaging methods (18F-fluorodeoxyglucose positron emission tomography/CT or diffusion-weighted imaging/MRI). It had low sensitivity for detection of small-volume macrometastases (largest diameter <5 mm) and micrometastases. The accuracy of para-aortic assessment was comparable to that for pelvic lymph nodes, and assessment of the para-aortic region should be an inseparable part of the examination protocol. Competing Interests: Competing interests: None declared. (© IGCS and ESGO 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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