title: Prospective evaluation of 18-fluoro-2-deoxy-D-glucose positron emission tomography for the discrimination of paraaortic nodal spread in patients with 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 cases of paraaortic nodal spread. Nowadays, 18-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) is considered to be the most accurate image method of detection of node or distant metastases. The goal of this study was to evaluate the accuracy of FDG-PET for detecting paraaortic lymph node (PALN) spread in patients with LACC.
  
  
  METHODS
  Patients with LACC from 2 tertiary university hospitals in Madrid, Spain, were submitted to a laparoscopic infrarenal PALN dissection after FDG-PET evaluation. Based on pathologic results as gold standard, sensitivity, specificity, and positive and negative predictive values of FDG-PET were calculated thereafter for PALN metastasis.
  
  
  RESULTS
  A total of 52 patients with LACC fulfilled the inclusion criteria. All of them underwent a laparoscopic infrarenal paraaortic lymphadenectomy. Eighteen patients (34.6%) had pathologically proven PALN metastases. Among them, 4 (12.5%) had negative FDG-PET (false negatives). Furthermore, 2 positive FDG-PET patients were not affected after histologic analysis (11.1% false positives). No complications occurred in our series. Sensitivity, specificity, and positive and negative predictive value of the FDG-PET were 77.7, 94.1, 87.5, and 88.9, respectively, for the detection of PALN metastases.
  
  
  CONCLUSIONS
  The sensitivity and specificity of FDG-PET remains limited, so PALN dissection should be part of the pretherapeutic staging in every patient with LACC before definitive concurrent chemoradiotherapy.
authors.affiliation: Department of Obstetrics and Gynecology, Autónoma University of Madrid, Puerta de Hierro University Hospital, Madrid, Spain. tperezm@sego.es
authors.forename: Tirso
authors.initials: T
authors.lastname: Perez-Medina
authors.forename: Augusto
authors.initials: A
authors.lastname: Pereira
authors.forename: Jorge
authors.initials: J
authors.lastname: Mucientes
authors.forename: Manuel
authors.initials: M
authors.lastname: García-Espantaleón
authors.forename: Jesús S
authors.initials: JS
authors.lastname: Jiménez
authors.forename: Laura
authors.initials: L
authors.lastname: Calles
authors.forename: Begoña
authors.initials: B
authors.lastname: Rodríguez
authors.forename: Enrique
authors.initials: E
authors.lastname: Iglesias
mesh_terms: D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*
chemical_list: D019788:Fluorodeoxyglucose F18