title: Standardized uptake value and metabolic tumor volume measured by ¹⁸F FDG PET/CT are sensitive biomarkers for the presence of lymph node metastasis in patients with cervical carcinoma.
abstract: The aim of this study was to evaluate whether tumor standardized uptake value (SUVmax) and metabolic tumor volume (MTV) associate with the presence of PET-positive pelvic/para-aortic lymph nodes (LN) in cervical cancer patients.
  
  
  METHODS
  Seventy-four patients with stage IB-IVB cervical cancer (squamous [n:66], nonsquamous [n:8]), who were referred to FDG-PET/CT department for initial staging, were enrolled in this study.
  
  
  RESULTS
  Patients were staged according to International Federation of Gynecology and Obstetrics [FIGO] criteria as; stage I (n:5), stage II (n:25), stage III (n:15) and stage IV (n:29). PET/CT detected 53 patients with hypermetabolic LN (average SUVmax: 7.5 ± 4.1, range: 4.1-22.8, pelvic LN: 29 patients, para-aortic LN:5 patients, pelvic and para-aortic LN:19 patients). SUVmax and MTV were significantly higher in patients with PET-positive LN compared to others (18.4 and 88.8 cm(3) vs. 13.9 and 39.9 cm(3) respectively, p = 0.007 for SUVmax, p = 0.0001 for MTV). Cut-off values in association with PET-positive LN were 15.2 for SUVmax and 35 cm(3) for MTV on ROC curve analysis. There was no correlation between SUVmax and MTV (correlation coefficient (R(2)) = 0.07). MTV differed significantly with FIGO stages (41, 98 and 107 cm(3), in stage II, III and IV respectively, p = 0.015).
  
  
  CONCLUSIONS
  Presence of PET-positive LN correlates with tumor SUVmax and MTV of cervical tumor. These findings support the use of PET/CT in the pretreatment evaluation of cervical cancer patients in order to identify cases with high risk of lymphatic involvement.
authors.affiliation: Department of Nuclear Medicine, Ankara Oncology Education and Research Hospital, Ankara, Turkey. Electronic address: drgulin@yahoo.com.
authors.forename: G U
authors.initials: GU
authors.lastname: Vural
authors.affiliation: Department of Nuclear Medicine, Ankara Oncology Education and Research Hospital, Ankara, Turkey.
authors.forename: B E
authors.initials: BE
authors.lastname: Akkas
authors.affiliation: Department of Nuclear Medicine, Ankara Oncology Education and Research Hospital, Ankara, Turkey.
authors.forename: B B
authors.initials: BB
authors.lastname: Demirel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics*; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000378:metabolism*
chemical_list: D014408:Biomarkers, Tumor; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Cervical cancer; Cáncer cervical; FDG; Implicación linfática; Lymphatic involvement; Metabolic tumor volume; PET/CT; PET/TC; SUVmax; Volumen tumoral metabólico