FDG PET/CT in staging of advanced epithelial ovarian cancer: Frequency of supradiaphragmatic lymph node metastasis challenges the traditional pattern of disease spread
| Autor: | Marko Seppänen, Irina Lisinen, Johanna Virtanen, Annika Auranen, Kirsti Dean, Jukka Kemppainen, Maija Lavonius, Johanna Hynninen, Seija Grénman, Olli Carpén |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
medicine.medical_specialty
Diaphragm Carcinoma Ovarian Epithelial Fluorodeoxyglucose F18 Ascites Carcinoma medicine Humans Neoplasms Glandular and Epithelial Aged Neoplasm Staging Ovarian Neoplasms ta3126 medicine.diagnostic_test business.industry Obstetrics and Gynecology Middle Aged medicine.disease ta3123 Parasternal lymph nodes Lymphatic system Oncology Positron emission tomography Parasternal line Lymphatic Metastasis Positron-Emission Tomography Female Histopathology Disease Susceptibility Lymph Nodes Lymph Radiology Radiopharmaceuticals medicine.symptom business |
| Zdroj: | Gynecologic Oncology. 126:64-68 |
| ISSN: | 0090-8258 |
| Popis: | Epithelial ovarian cancer (EOC) spreads intra-abdominally and to the retroperitoneal lymph nodes. A greater number of distant metastases are revealed by (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) compared to conventional imaging methods. We aimed to investigate the presence and anatomic distribution of supradiaphragmatic lymph node metastasis (LNM) detected with pretreatment FDG PET/CT.Thirty women with advanced stage (IIC-IV) EOC were scanned with whole body contrast-enhanced FDG PET/CT prior to surgery/neoadjuvant chemotherapy. We performed PET/CT analysis qualitatively and quantitatively. Additionally, contrast-enhanced CT was analyzed blinded to PET/CT scan. Intra-abdominal dissemination was verified by surgery and histopathology. Metabolically active lymph nodes were biopsied when possible. The clinical characteristics of patients with and without supradiaphragmatic LNM were compared.In 20/30 patients (67%) FDG PET/CT detected supradiaphragmatic LNM in one or more locations, whereas conventional CT found LNM in 10 patients (33%). Fourteen patients had parasternal, 14 cardiophrenic, 8 other mediastinal, 6 axillar, and 1 subclavian LNM. Microscopy of all four biopsied lymph nodes (three axillar and one subclavian) confirmed metastatic dissemination. The patients with supradiaphragmatic LNM had significantly more ascites (p0.01), higher CA 125 levels, and more frequent subdiaphragmal carcinomatosis (p0.03) compared to patients without supradiaphragmatic LNM in preoperative FDG PET/CT.A significant number of patients with advanced EOC showed supradiaphragmatic LNM in pre-treatment PET/CT. Our findings suggest that the route of EOC cells from the peritoneal cavity to the lymphatic system permeates the diaphragm mainly to the cardiophrenic and continues to parasternal lymph nodes. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect