Tumour and pelvic lymph node metabolic activity on FDG-PET/CT to stratify patients for para-aortic surgical staging in locally advanced cervical cancer
| Autor: | Laurence Gladieff, M Voglimacci, Frédéric Courbon, Amélie Lusque, C Martinez, Anne Ducassou, Ninon Dupuis, Elodie Chantalat, Y Tanguy Le Gac, Martina Aida Angeles, Erwan Gabiache, Gwenael Ferron, A Hitzel, Alejandra Martinez |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Locally advanced Uterine Cervical Neoplasms Surgical staging 030218 nuclear medicine & medical imaging Metastasis 03 medical and health sciences 0302 clinical medicine Fluorodeoxyglucose F18 Positron Emission Tomography Computed Tomography Medicine Humans Radiology Nuclear Medicine and imaging Lymph node Neoplasm Staging Retrospective Studies Cervical cancer Receiver operating characteristic business.industry General Medicine medicine.disease Dissection medicine.anatomical_structure 030220 oncology & carcinogenesis Lymphadenectomy Female Radiology Lymph Nodes Neoplasm Recurrence Local Radiopharmaceuticals business |
| Zdroj: | European journal of nuclear medicine and molecular imaging. 47(5) |
| ISSN: | 1619-7089 |
| Popis: | The aim of our study was to comprehensively evaluate the most valuable metabolic parameters of cervical tumours and pelvic lymph nodes (PLN) by FDG-PET/CT to predict para-aortic lymph node (PALN) metastasis and stratify patients for surgical staging. The study included patients with locally advanced cervical cancer, negative PALN uptake on preoperative FDG-PET/CT, and para-aortic lymphadenectomy. Two senior nuclear medicine physicians expert in gynaecologic oncology reviewed all PET/CT exams, and extracted tumour SUVmax, MTV, and TLG, as well as PLN. Prognostic parameters of PALN involvement were identified using ROC curves and logistic regression analysis. One hundred and twenty-five consecutive locally advanced cervical cancer patients were included. The FDG-PET/CT false-negative rate was, respectively, 27.7% (13/47) and 5.1% (4/78) in patients with and without FDG-PET/CT PLN uptake. The AUC of cervical tumour size, SUVmax, MTV, and TLG was, respectively, 0.75 (0.62–0.87), 0.59 (0.44–0.76), 0.75 (0.60–0.90), and 0.71 (0.56–0.86). The AUC of PLN size, SUVmax, SUVmean, PLN SUVmax/Tumour SUVmax ratio, MTV, and TLG was, respectively, 0.57 (0.37–0.78), 0.82 (0.68–0.95), 0.77 (0.61–0.94), 0.85 (0.72–0.98), 0.69 (0.51–0.87), and 0.74 (0.57–0.91). The metabolic parameter showing the best trade-off between sensitivity and specificity to predict PALN involvement was the ratio between PLN and tumour SUVmax. The risk of PALN metastasis in FDG-PET/CT negative PLN patients is very low, so para-aortic lymphadenectomy does not seem justified. In patients with preoperative PLN uptake on FDG-PET/CT, surgical staging led to treatment modification in more than 25% of cases and should therefore be performed. Patients with more than one positive PLN and high PLN metabolic activity are at high risk of para-aortic extension and recurrence. Further prospective evaluation is required to consider intensified treatment modalities without prior PALN dissection. |
| Databáze: | OpenAIRE |
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