title: Utility of PET-CT to evaluate retroperitoneal lymph node metastasis in advanced cervical cancer: Results of ACRIN6671/GOG0233 trial.
abstract: OBJECTIVE
  To assess if FDG PET combined with diagnostic CT improves diagnostic CT accuracy to detect lymph node (LN) metastasis in advanced cervical cancer.
  
  
  METHODS
  A prospective HIPAA compliant ACRIN/GOG multicenter trial was conducted. Patients underwent concurrent diagnostic contrast-enhanced CT (DCT) and PET and pelvic/abdominal lymphadenectomy. Seven independent blinded readers reviewed PET-DCT and DCT one-month apart. Reference standard was surgically removed LN pathology. Accuracy values were calculated at participant level, correlating abdominal (right and left para-aortic/common iliac) and pelvic (right and left external iliac/obturator) LN regions with pathology, respecting laterality. Reader average sensitivities/specificities of PET-DCT vs. DCT were compared with generalized linear mixed models, and AUCs with Obuchowski's method.
  
  
  RESULTS
  One hundred fifty-three patients had PET-DCT and pathology. Forty-three of 153 patients had metastasis to abdominal LNs. Sample size calculation required review of the first 40 abdominal positive and 40 randomly selected abdominal negative studies. Patients were 24 to 74years (48.9±10.6) old. Mean sensitivities of PET-DCT/DCT for detection of LN metastasis in abdomen were 0.50 (CI: 0.44, 0.56) and 0.42 (CI: 0.36, 0.48) (p=0.052) and in pelvis 0.83 (CI: 0.78, 0.87) and 0.79 (CI: 0.73, 0.83) (p=0.15). Corresponding specificities were 0.85 (CI: 0.80, 0.89) and 0.89 (CI: 0.84, 0.92) (p=0.21) and 0.63 (CI: 0.54, 0.70) and 0.62 (CI: 0.53, 0.69) (p=0.83). Mean AUC values were 0.70 (CI: 0.61, 0.79) and 0.68 (CI: 0.59, 0.77) (p=0.43) and 0.80 (CI: 0.71, 0.88) and 0.76 (CI: 0.67, 0.85) (p=0.21) respectively.
  
  
  CONCLUSIONS
  Addition of PET to DCT resulted in statistically borderline increase in sensitivity to detect LN metastasis in abdomen in advanced cervical cancer.
authors.affiliation: University Health Network, Canada. Electronic address: mostafa.atri@uhn.ca.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Atri
authors.affiliation: Brown University, United States.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Washington University School of Medicine, United States.
authors.forename: Farrokh
authors.initials: F
authors.lastname: Dehdashti
authors.affiliation: Massachusetts General Hospital, United States.
authors.forename: Susanna I
authors.initials: SI
authors.lastname: Lee
authors.affiliation: Roswell Park Cancer Institute, United States.
authors.forename: Shamshad
authors.initials: S
authors.lastname: Ali
authors.affiliation: Brown University, United States.
authors.forename: Helga
authors.initials: H
authors.lastname: Marques
authors.affiliation: Washington University, United States.
authors.forename: Wui-Jin
authors.initials: WJ
authors.lastname: Koh
authors.affiliation: University of Oklahoma Health Science Center, United States.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Moore
authors.affiliation: University of Oklahoma Health Science Center, United States.
authors.forename: Lisa
authors.initials: L
authors.lastname: Landrum
authors.affiliation: Seoul National University College of Medicine, Republic of Korea.
authors.forename: Jae Weon
authors.initials: JW
authors.lastname: Kim
authors.affiliation: Stony Brook, United States.
authors.forename: Paul
authors.initials: P
authors.lastname: DiSilvestro
authors.affiliation: University of Cincinnati, United States.
authors.forename: Eric
authors.initials: E
authors.lastname: Eisenhauer
authors.affiliation: Central Georgia Cancer Care, United States.
authors.forename: Frederick
authors.initials: F
authors.lastname: Schnell
authors.affiliation: Tulsa Cancer Institute, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Gold
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods; D011446:Prospective Studies; D012187:Retroperitoneal Space / Q000000981:diagnostic imaging / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D055815:Young Adult
keywords: CT; Cervical cancer; Lymph node metastasis; PET-CT