A prospective trial comparing lymphangiogram, cross-sectional imaging, and positron emission tomography scan in the detection of lymph node metastasis in locally advanced cervical cancer.
OBJECTIVE
This study prospectively evaluated the use of lymphangiogram, computed tomography/magnetic resonance imaging, and positron emission tomography (PET) imaging of lymph node metastasis in patients receiving definitive chemoradiotherapy for cervical cancer.


METHODS
Twenty patients underwent lymphangiogram, computed tomography/magnetic resonance imaging, and PET. There was no histologic verification of metastasis. Four lymph node regions, including the internal, external, and common iliacs, and para-aortic, were scored as positive or negative for metastasis. Agreement between imaging was analyzed using multirater kappa and disease-free survival utilizing Kaplan Meier survival curves and log-rank test.


RESULTS
Agreement between imaging was most consistent in the common iliacs (P < 0.001) and least in the para-aortic region (P = 0.41). Disease-free survival (DFS) at one year was statistically associated with positive PET imaging (25%) versus negative PET imaging (86%) (P = 0.033) in the common iliac lymph node region. No other single lymph node region in any modality was statistically associated with DFS. One-year DFS in patients with any positive areas on PET imaging was 50% compared with 90% in patients with negative PET imaging (P = 0.02). Seven patients were noted to have no metastasis in any region by all 3 of the imaging modalities; the 1-year DFS in these 7 patients was 100% compared with 59% in the 13 patients with any positive nodal area (P = 0.05).


CONCLUSIONS
Positive lymphadenopathy on PET imaging was associated with reduced DFS.
Small
William
W
Department of Radiation Oncology, The Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA. wsmall@nmff.org
Vern
Tamara Z
TZ
Rademaker
Alfred
A
Nemcek
Albert
A
Spies
Stewart
S
Schink
Julian C
JC
Singh
Diljeet K
DK
Lurain
John R
JR
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000556:secondary; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000556:secondary; D003430:Cross-Sectional Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008220:Lymphography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011379:Prognosis; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18