title: Accuracy of 18-fluoro-2-deoxy-D-glucose positron emission tomography in the pretherapeutic detection of occult para-aortic node involvement in patients with a locally advanced cervical carcinoma.
abstract: OBJECTIVE
  Patients with locally advanced cervical cancer (LACC) are usually treated with concurrent chemoradiotherapy. Extended-field chemoradiotherapy is indicated in case of para-aortic node involvement at initial assessment. 18-Fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18-FDG PET/CT) is currently considered to be the most accurate method of detection of node or distant metastases. The goal of this study was to evaluate the accuracy of PET at detecting para-aortic lymph node metastases in LACC patients with a negative morphological imaging.
  
  
  METHODS
  Patients from five French institutions with LACC and both negative morphologic (magnetic resonance imaging, CT scan) and functional (PET or PET/CT) findings at the para-aortic level and distantly were submitted to a systematic infrarenal para-aortic node dissection either by laparoscopy or laparotomy. On the basis of pathological results, sensitivity, specificity, and positive and negative predictive values of PET/CT were assessed for para-aortic lymph node involvement.
  
  
  RESULTS
  A total of 125 LACC patients (stage IB2-IVA disease with two local recurrences) fulfilled the inclusion criteria. All had an ilio-infrarenal para-aortic lymphadenectomy, either by laparoscopy (n = 117) or laparotomy (n = 8). Twenty-one patients (16.8%) had pathologically proven para-aortic metastases. Among them, 14 (66.7%) had negative PET/CT. Overall morbidity of surgery was 7.2%. All but one of the complications were mild and did not delay chemoradiotherapy. Sensitivity, specificity, and positive and negative predictive value of the PET/CT were 33.3, 94.2, 53.8, and 87.5%, respectively, for the detection of microscopic lymph node metastases.
  
  
  CONCLUSIONS
  Laparoscopic staging surgery seems warranted in LACC patients with negative PET scan who are candidates for definitive concurrent chemoradiotherapy or exenteration.
authors.affiliation: Centre Oscar Lambret, Lille, France. e-leblanc@o-lambret.fr
authors.forename: E
authors.initials: E
authors.lastname: Leblanc
authors.forename: H
authors.initials: H
authors.lastname: Gauthier
authors.forename: D
authors.initials: D
authors.lastname: Querleu
authors.forename: G
authors.initials: G
authors.lastname: Ferron
authors.forename: S
authors.initials: S
authors.lastname: Zerdoud
authors.forename: P
authors.initials: P
authors.lastname: Morice
authors.forename: C
authors.initials: C
authors.lastname: Uzan
authors.forename: S
authors.initials: S
authors.lastname: Lumbroso
authors.forename: F
authors.initials: F
authors.lastname: Lecuru
authors.forename: A S
authors.initials: AS
authors.lastname: Bats
authors.forename: N
authors.initials: N
authors.lastname: Ghazzar
authors.forename: M
authors.initials: M
authors.lastname: Bannier
authors.forename: G
authors.initials: G
authors.lastname: Houvenaeghel
authors.forename: I
authors.initials: I
authors.lastname: Brenot-Rossi
authors.forename: F
authors.initials: F
authors.lastname: Narducci
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000628:therapy; D018262:Adenocarcinoma, Clear Cell / Q000175:diagnosis* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000628:therapy; D002648:Child; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000628:therapy; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000628:therapy; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18