Role of integrated PET-CT in pelvic lymph node staging of cervical cancer before radical hysterectomy.
BACKGROUND
To investigate the feasibility of preoperative integrated positron emission tomography-computed tomography (PET-CT) with fluoro-2-deoxy-D-glucose (FDG) in primary pelvic lymph node (LN) staging before radical hysterectomy (RH) and pelvic lymphadenectomy (PLND) in cervical cancer.


METHODS
We reviewed medical records of all patients with FIGO stage IA2-IIB cervical cancer who underwent a preoperative FDG PET-CT and underwent type II or III RH and PLND between January 1, 2003, and July 31, 2007.


RESULTS
A total of 34 patients underwent preoperative PET-CT scans followed by RH and PLND during the study period. Of the 34 patients, 17 (50.0%) had pelvic LN metastases, and the median number of harvested LNs was 29 (range 13-57). The overall region-specific sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PET-CT were 36.4, 98.8, 85.7, 88.9, and 88.7%, respectively. The patients with positive preoperative PET-CT scans showed higher recurrence rates (3/8) than those with negative scans (1/26); the difference was statistically significant (p = 0.031).


CONCLUSIONS
Integrated PET-CT scan has limited sensitivity, but high specificity for predicting pelvic LN metastasis in preoperative staging of invasive cervical cancer. Furthermore, preoperative integrated PET-CT may be a useful tool for identifying patients with higher risk of cervical cancer recurrence.
Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Hyun Hoon
HH
Chung
Noh-Hyun
NH
Park
Jae Weon
JW
Kim
Yong-Sang
YS
Song
June-Key
JK
Chung
Soon-Beom
SB
Kang
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery