Lymph node metastasis in patients with clinical early-stage cervical cancer: Detection with integrated FDG PET/CT

Sandro Sironi, Alessandro Buda, Maria Picchio, Patrizia Perego, Rossella Moreni, Antonio Pellegrino, Mario Colombo, Costantino Mangioni, Cristina Messa, Ferruccio Fazio

Research output: Contribution to journalArticle

Abstract

Purpose: To prospectively determine the accuracy of combination positron emission tomography-computed tomography (PET/CT) in lymph node staging in patients with early-stage cervical cancer, with histopathologic results as the reference standard. Materials and Methods: The study was institutional review board approved, and all patients gave informed consent. Forty-seven consecutive women aged 29-71 years with clinical stage IA or IB cervical carcinoma were included in the study. All 47 patients were scheduled for radical hysterectomy with pelvic lymph node dissection. Before surgery, all patients underwent fluorine 18 fluorodeoxyglucose (FDG) PET/CT. PET/CT findings were interpreted by two readers in consensus and then compared with histopathologic results. At histopathologic examination, the dissected lymph nodes were classified as nonmetastatic or metastatic. Results: Fifteen (32%) patients had metastatic lymph nodes at histopathologic examination, and 32 (68%) had no histopathologically confirmed nodal metastasis. Of the total 1081 lymph nodes histopathologically sampled, 18 were found to be positive for malignant cells. The overall node-based sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/CT were 72% (13 of 18), 99.7% (1060 of 1063), 81% (13 of 16), 99.5% (1060 of 1065), and 99.3% (1073 of 1081), respectively. Corresponding values for PET/CT-based diagnosis of lymph nodes larger than 0.5 cm in diameter were 100% (13 of 13), 99.6% (675 of 678), 81% (13 of 16), 100% (675 of 675), and 99.6% (688 of 691), respectively. The overall patient-based sensitivity, specificity, PPV, NPV, and accuracy of PET/CT were 73% (11 of 15), 97% (31 of 32), 92% (11 of 12), 89% (31 of 35), and 89% (42 of 47), respectively. Conclusion: PET/CT proved to be valuable for lymph node staging in patients with early-stage cervical cancer, with short-axis diameter greater than 0.5 cm being the size threshold for accurate depiction of metastatic nodes.

Original languageEnglish
Pages (from-to)272-279
Number of pages8
JournalRadiology
Volume238
Issue number1
DOIs
Publication statusPublished - Jan 2006

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Uterine Cervical Neoplasms
Lymph Nodes
Neoplasm Metastasis
Sensitivity and Specificity
Research Ethics Committees
Fluorodeoxyglucose F18
Positron Emission Tomography Computed Tomography
Lymph Node Excision
Informed Consent
Hysterectomy
Carcinoma

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology

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Lymph node metastasis in patients with clinical early-stage cervical cancer : Detection with integrated FDG PET/CT. / Sironi, Sandro; Buda, Alessandro; Picchio, Maria; Perego, Patrizia; Moreni, Rossella; Pellegrino, Antonio; Colombo, Mario; Mangioni, Costantino; Messa, Cristina; Fazio, Ferruccio.

In: Radiology, Vol. 238, No. 1, 01.2006, p. 272-279.

Research output: Contribution to journalArticle

Sironi, S, Buda, A, Picchio, M, Perego, P, Moreni, R, Pellegrino, A, Colombo, M, Mangioni, C, Messa, C & Fazio, F 2006, 'Lymph node metastasis in patients with clinical early-stage cervical cancer: Detection with integrated FDG PET/CT', Radiology, vol. 238, no. 1, pp. 272-279. https://doi.org/10.1148/radiol.2381041799
Sironi, Sandro ; Buda, Alessandro ; Picchio, Maria ; Perego, Patrizia ; Moreni, Rossella ; Pellegrino, Antonio ; Colombo, Mario ; Mangioni, Costantino ; Messa, Cristina ; Fazio, Ferruccio. / Lymph node metastasis in patients with clinical early-stage cervical cancer : Detection with integrated FDG PET/CT. In: Radiology. 2006 ; Vol. 238, No. 1. pp. 272-279.
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abstract = "Purpose: To prospectively determine the accuracy of combination positron emission tomography-computed tomography (PET/CT) in lymph node staging in patients with early-stage cervical cancer, with histopathologic results as the reference standard. Materials and Methods: The study was institutional review board approved, and all patients gave informed consent. Forty-seven consecutive women aged 29-71 years with clinical stage IA or IB cervical carcinoma were included in the study. All 47 patients were scheduled for radical hysterectomy with pelvic lymph node dissection. Before surgery, all patients underwent fluorine 18 fluorodeoxyglucose (FDG) PET/CT. PET/CT findings were interpreted by two readers in consensus and then compared with histopathologic results. At histopathologic examination, the dissected lymph nodes were classified as nonmetastatic or metastatic. Results: Fifteen (32{\%}) patients had metastatic lymph nodes at histopathologic examination, and 32 (68{\%}) had no histopathologically confirmed nodal metastasis. Of the total 1081 lymph nodes histopathologically sampled, 18 were found to be positive for malignant cells. The overall node-based sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/CT were 72{\%} (13 of 18), 99.7{\%} (1060 of 1063), 81{\%} (13 of 16), 99.5{\%} (1060 of 1065), and 99.3{\%} (1073 of 1081), respectively. Corresponding values for PET/CT-based diagnosis of lymph nodes larger than 0.5 cm in diameter were 100{\%} (13 of 13), 99.6{\%} (675 of 678), 81{\%} (13 of 16), 100{\%} (675 of 675), and 99.6{\%} (688 of 691), respectively. The overall patient-based sensitivity, specificity, PPV, NPV, and accuracy of PET/CT were 73{\%} (11 of 15), 97{\%} (31 of 32), 92{\%} (11 of 12), 89{\%} (31 of 35), and 89{\%} (42 of 47), respectively. Conclusion: PET/CT proved to be valuable for lymph node staging in patients with early-stage cervical cancer, with short-axis diameter greater than 0.5 cm being the size threshold for accurate depiction of metastatic nodes.",
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T1 - Lymph node metastasis in patients with clinical early-stage cervical cancer

T2 - Detection with integrated FDG PET/CT

AU - Sironi, Sandro

AU - Buda, Alessandro

AU - Picchio, Maria

AU - Perego, Patrizia

AU - Moreni, Rossella

AU - Pellegrino, Antonio

AU - Colombo, Mario

AU - Mangioni, Costantino

AU - Messa, Cristina

AU - Fazio, Ferruccio

PY - 2006/1

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N2 - Purpose: To prospectively determine the accuracy of combination positron emission tomography-computed tomography (PET/CT) in lymph node staging in patients with early-stage cervical cancer, with histopathologic results as the reference standard. Materials and Methods: The study was institutional review board approved, and all patients gave informed consent. Forty-seven consecutive women aged 29-71 years with clinical stage IA or IB cervical carcinoma were included in the study. All 47 patients were scheduled for radical hysterectomy with pelvic lymph node dissection. Before surgery, all patients underwent fluorine 18 fluorodeoxyglucose (FDG) PET/CT. PET/CT findings were interpreted by two readers in consensus and then compared with histopathologic results. At histopathologic examination, the dissected lymph nodes were classified as nonmetastatic or metastatic. Results: Fifteen (32%) patients had metastatic lymph nodes at histopathologic examination, and 32 (68%) had no histopathologically confirmed nodal metastasis. Of the total 1081 lymph nodes histopathologically sampled, 18 were found to be positive for malignant cells. The overall node-based sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/CT were 72% (13 of 18), 99.7% (1060 of 1063), 81% (13 of 16), 99.5% (1060 of 1065), and 99.3% (1073 of 1081), respectively. Corresponding values for PET/CT-based diagnosis of lymph nodes larger than 0.5 cm in diameter were 100% (13 of 13), 99.6% (675 of 678), 81% (13 of 16), 100% (675 of 675), and 99.6% (688 of 691), respectively. The overall patient-based sensitivity, specificity, PPV, NPV, and accuracy of PET/CT were 73% (11 of 15), 97% (31 of 32), 92% (11 of 12), 89% (31 of 35), and 89% (42 of 47), respectively. Conclusion: PET/CT proved to be valuable for lymph node staging in patients with early-stage cervical cancer, with short-axis diameter greater than 0.5 cm being the size threshold for accurate depiction of metastatic nodes.

AB - Purpose: To prospectively determine the accuracy of combination positron emission tomography-computed tomography (PET/CT) in lymph node staging in patients with early-stage cervical cancer, with histopathologic results as the reference standard. Materials and Methods: The study was institutional review board approved, and all patients gave informed consent. Forty-seven consecutive women aged 29-71 years with clinical stage IA or IB cervical carcinoma were included in the study. All 47 patients were scheduled for radical hysterectomy with pelvic lymph node dissection. Before surgery, all patients underwent fluorine 18 fluorodeoxyglucose (FDG) PET/CT. PET/CT findings were interpreted by two readers in consensus and then compared with histopathologic results. At histopathologic examination, the dissected lymph nodes were classified as nonmetastatic or metastatic. Results: Fifteen (32%) patients had metastatic lymph nodes at histopathologic examination, and 32 (68%) had no histopathologically confirmed nodal metastasis. Of the total 1081 lymph nodes histopathologically sampled, 18 were found to be positive for malignant cells. The overall node-based sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/CT were 72% (13 of 18), 99.7% (1060 of 1063), 81% (13 of 16), 99.5% (1060 of 1065), and 99.3% (1073 of 1081), respectively. Corresponding values for PET/CT-based diagnosis of lymph nodes larger than 0.5 cm in diameter were 100% (13 of 13), 99.6% (675 of 678), 81% (13 of 16), 100% (675 of 675), and 99.6% (688 of 691), respectively. The overall patient-based sensitivity, specificity, PPV, NPV, and accuracy of PET/CT were 73% (11 of 15), 97% (31 of 32), 92% (11 of 12), 89% (31 of 35), and 89% (42 of 47), respectively. Conclusion: PET/CT proved to be valuable for lymph node staging in patients with early-stage cervical cancer, with short-axis diameter greater than 0.5 cm being the size threshold for accurate depiction of metastatic nodes.

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