ERKEN EVRE UTERİN SERVİKS KANSERLİ HASTALARDA PELVİK VE PARAAORTİK LENF NODU METASTAZLARININ SAPTANMASINDA 18F-FDG PET / BT'NİN TANISAL DEĞERİNİN BELİRLENMESİ To Determine the Diagnostic Value of 18F-FDG PET / CT in Detecting Pelvic and Paraaortic lymph Node Metastases in Patients with Early Stage Uterine Cervix Cancer.

Year 2019, Volume: 9 Issue: 4, 56 - 63, 27.12.2019

Mustafa Tas , Adem Yavuz Eser Kaya Bülent Özçelik

Abstract

ÖZET
Amaç: Bu çalışmanın amacı, erken evre uterin serviks kanserli hastalarda pelvik ve paraaortik lenf nodu
metastazlarının saptanmasında 18F-florodeoksiglukoz Pozitron Emisyon tomografisi / Bilgisayarlı Tomografi
(PET/BT) 'nin tanısal değerini belirlemekti.
Gereç ve Yöntem: Radikal histerektomi ve sistemik pelvik ve paraaortik lenf nodu diseksiyonu öncesi PET/
BT görüntülemesi yapılan erken evre uterin serviks kanserli 18 hasta çalışmaya dahil edildi. Lenf nodlarının
histopatolojik değerlendirmesi tanısal standart olarak kabul edildi ve PET/BT bulguları histopatolojik bulgularla
karşılaştırıldı.
Bulgular: 18 hastadan toplam 807 (577 pelvik - 230 paraaortik) lenf nodu örneklendi ve histopatolojik
incelemede 5 (% 28) hastada 10 (%1,2) nod (8 pelvik - 2 paraaortik) pozitif bulundu. Genel nod bazlı PET/
BT'nin duyarlılık, özgüllük, pozitif prediktif değer (PPV), negatif prediktif değer (NPV) ve doğruluğu sırasıyla %
10 (1/10), % 100 (797/797), %100 (1/1) % 99 (797/806) ve % 99 (798/807) idi.
Genel hasta bazlı PET/BT'nin duyarlılık, özgüllük, PPV, NPV ve doğruluğu sırasıyla %20 (1/5), %100 (13/13), %
100 (1/1), % 76 (13/17), %78 (14/18) idi.
Sonuç: Erken evre uterin serviks kanserli hastaların yönetiminde, mikrometastatik lenf nodu olan hastaların
PET / BT'de yanlış negatif olarak rapor edilebileceği akılda tutulmalıdır.
Anahtar Kelimeler: Erken evre uterin serviks kanseri; Preoperatif FDG PET/BT; Pelvik ve paraaortik lenf nodu
metastazı.
ABSTRACT
Objective: The aim of this study was to determine the diagnostic value of 18F-fluorodeoxyglucose Positron
Emission Tomography / Computed Tomography (PET / CT) in detection of pelvic and paraaortic lymph node
metastases in patients with early stage uterine cervix cancer.
Materials and Methods: 18 patients with early stage uterine cervix cancer who underwent PET / CT imaging
before radical hysterectomy and systemic pelvic and paraaortic lymph node dissection were included in the
study. Histopathological evaluation of lymph nodes was accepted as the diagnostic standard and PET/CT
findings were compared with histopathological findings.
Results: Of the total 807 (577 pelvic ve 230 para- aortic) lymph nodes sampled from 18 patients, and 10
(1,2%) nodes (8 pelvik ve 2 paraaortic) in 5 (28%) patients were positive for metastasis at histopathologic
examination. The overall node-based sensitivity, specificity, positive predictive value (PPV), negative predictive
value (NPV), and accuracy of PET/CT were 10% (1of 10), 100% (797 of 797), 100% (1 of 1), 99% (797 of 806),
and 99% (798 of 807), respectively. Meanwhile, the overall patient-based sensitivity, specificity, PPV, NPV,
and accuracy of PET/CT were 20% (1 of 5), 100% (13 of 13), 100% (1 of 1), 76% (13 of 17), and 78% (14 of 18),
respectively.
Conclusions: In the management of patients with early stage uterine cervix cancer, it should be kept in mind
that patients with micro-metastatic lymph nodes can be reported as false negative in PET / CT.
Key words: Early stage uterine cervix cancer; Preoperative PET / CT; Pelvic and paraaortic lymph node
metastasis

Keywords

ERKEN EVRE UTERİN SERVİKS KANSERLİ HASTALARDA PELVİK VE PARAAORTİK LENF NODU METASTAZLARININ SAPTANMASINDA 18F-FDG PET / BT'NİN TANISAL DEĞERİNİN BELİRLENMESİ To Determine the Diagnostic Value of 18F-FDG PET / CT in Detecting Pelvic and Paraaortic lymph Node Metastases in Patients with Early Stage Uterine Cervix Cancer.

References

• 1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin, 2011; 61: 69-90. 2. National Comprehensive Cancer Network. Cervical Cancer. (Version 1.2016). http://www.nccn.org/professionals/physician_gls/pdf/ cervical. 3. Kidd EA, Siegel BA, Dehdashti F, Grigsby PW. Pelvic lymph node F-18 fluorodeoxyglucose uptake as a prognostic biomarker in newly diagnosed patients with locally advanced cervical cancer. Cancer, 2010; 116: 1469-75. 4. Nogami Y, Iida M, Banno K, et al. Application of FDG-PET in cervical cancer and endometrial cancer: utility and future prospects. Anticancer Res, 2014; 34: 585-92. 5. Pecorelli S, Zigliani L, Odicino F. Revised FIGO staging for carcinoma of the cervix. Int J Gynaecol Obstet, 2009; 105: 107-8. 6. Kidd EA, Siegel BA, Dehdashti F, Rader JS, Mutch DG, Powell MA. Lymph node staging by positron emission tomography in cervical cancer: relationship to prognosis. J Clin Oncol, 2010; 28: 2108-13. 7. Chung H.H., Park N.H., Kim J.W.. Role of integrated PET-CT in pelvic lymph node staging of cervical cancer before radical hysterectomy, Gynecologic & Obstetric Investigation, 2009; 67(1) :61-66. 8. Grueneisen J., Schaarschmidt B.M., Heubner M.. Integrated PET/MRI for whole-body staging of patients with primary cervical cancer: preliminary results, European Journal of Nuclear Medicine & Molecular Imaging, 2015; 42: 1814. 9. Scheidler J, Hricak H, Yu KK, Subak L, Segal MR. Radiological evaluation of lymph node metastases in patients with cervical cancer. A meta-analysis. JAMA, 1997; 278: 1096-101. 10. Choi HJ, Roh JW, Seo SS, Lee S, Kim JY, Kim SK, et al. Comparison of the accuracy of magnetic resonance imaging and positron emission tomography/computed tomography in the presurgical detection of lymph node metastases in patients with uterine cervical carcinoma. Cancer, 2006; 106: 914–922. 11. Grigsby PW, Siegel BA, Dehdashti F. Lymph node staging by positron emission tomography in patients with carcinoma of the cervix. J Clin Oncol, 2001; 19:3745–3749. 12. Juweid ME, Cheson BD. Positron-emission tomography and assessment of cancer therapy. N Engl J Med, 2006; 354: 496-507. 13. Kostakoglu L, Leonard JP, Coleman M, Goldsmith SJ. The Role of FDG-PET Imaging in the Management of Lymphoma. Clin Adv Hematol Oncol, 2004 ;2(2) :115-21. 14. Higashi K, Clavo AC, Wahl RL. Does FDG uptake measure proliferative activity of human cancer cells? in vitro comparison with DNA flow cytometry and tritiated thymidine uptake. J Nucl Med, 1993; 34: 414-19. 15. Kidd EA, Siegel BA, Dehdashti F, Grigsby PW. The standardized uptake value for F-18 fluorodeoxyglucose is a sensitive predictive biomarker for cervical cancer treatment response and survival. Cancer, 2007; 110: 1738-44. 16. Magne N, Chargari C, Vicenzi L, et al. New trends in the evaluation and treatment of cervix cancer: the role of FDG-PET. Cancer Treat Rev, 2008 ;34:671-681. 17. Grigsby PW. The contribution of new imaging techniques in staging cervical cancer. Gynecol Oncol, 2007; 107(1): 10-12. 18. Girardi F, Haas J. The importance of the histologic processing of pelvic lymph nodes in the treatment of cervical cancer. Int J Gynecol Cancer, 1993; 3:12-17. 19. Michel G, Morice P, Castaigne D, Leblanc M, Rey A, Duvillard P. Lymphatic spread in stage Ib and II cervical carcinoma: anatomy and surgical implications. Obstet Gynecol, 1998; 91: 360–363. 20. Sakuragi N, Satoh C, Takeda N, Hareyama H, Takeda M, Yamamoto R, et al. Incidence and distribution pattern of pelvic and paraaortic lymph node metastasis in patients with stages IB, IIA, and IIB cervical carcinoma treated with radical hysterectomy. Cancer, 1999; 85:1547-1554. 21. Havrilesky LJ, Kulasingam SL, Matchar DB and Myers ER: FDG-PET for management of cervical and ovarian cancer. Gynecol Oncol, 2005; 97: 183-191. 22. Reinhardt M. J., Ehritt-Braun C., Vogelgesang D., Ihling C., Hogerle S., Mix M., et al. Metastatic lymph nodes in patients with cervical cancer: detection with MR imaging and FDG PET.Radiology, 2001; 218: 776-782. 23. Roh J. W., Seo S. S., Lee S., Kang K. W., Kim S. K., Sim J. S., et al. Role of positron emission tomography in pretreatment lymph node staging of uterine cervical cancer: a prospective surgicopathologic correlation study. Eur. J. Cancer, 2005; 41: 2086-2092.24. Wright J. D., Dehdashti F., Herzog T. J., Mutch D. G., Huettner P. C., Rader J. S., et al. Preoperative lymph node staging of early-stage cervical carcinoma by [18F]-fluoro-2-deoxy-D-glucose-positron emission tomography. Cancer, 2005;104: 2484–2491. 25. Sironi S., Buda A., Picchio M., Perego P., Moreni R., Pellegrino A., et al. (2006). Lymph node metastasis in patients with clinical early-stage cervical cancer: detection with integrated FDG PET/CT. Radiology, 2006; 238: 272–279. 26. Kuan Lv, Hui-min Guo , Ying-jv Lu , Zhi-xing Wu , Ke Zhang and Jian-kui Han. Role of 18F-FDG PET/CT in detecting pelvic lymph-node metastases in patients with early-stage uterine cervical cancer: comparison with MRI findings. Nuclear Medicine Communications, 2014; 35:1204-1211. 27. Belhocine T, Thille A, Fridman V, et al: Contribution of whole-body (18)FDG-PET imaging in the management of cervical cancer. Gynecol Oncol, 2002; 87:90-97. 28. Williams AD, Cousins C, Soutter WP, et al: Detection of pelvic lymph node metastases in gynecologic malignancy: A comparison of CT, MR imaging, and positron emission tomography. AJR Am J Roentgenol, 2001; 177:343-348. 29. Chou H. H., Chang T. C., Yen T. C., Ng K. K., Hsueh S., Ma S. Y., et al. Low value of [18F]-fluoro-2-deoxy-D-glucose positron emission tomography in primary staging of early-stage cervical cancer before radical hysterectomy. J. Clin. Oncol, 2006; 24: 123–128. 30. Tomohito Tanaka; Shun Sasaki; Hiromitsu Tsuchihashi; Yoshito Terai; Kazuhiro Yamamoto; Takashi Yamada; Masahide Ohmichi. Which is better for predicting pelvic lymph node metastases in patients with cervical cancer: Fluorodeoxyglucose-positron emission tomography/computed tomography or a sentinel node biopsy? A retrospective observational study. Medicine. 97(16):e0410, APR 2018. 31. Kitajima K, Murakami K, Yamasaki E, et al. Accuracy of 18F-FDG PET/CT in detecting pelvic and paraaortic lymph node metastasis in patients with endometrial cancer. AJR Am J Roentgenol, 2008;190:1652–8. 32. Lukas R, Helena R, Jiri HM, Martin H, Petr S. Current status of sentinel lymph node mapping in the management of cervical cancer. Expert Rev Anticancer Ther, 2013; 13:861–870. 33. Crivellaro C, Signorelli M, Guerra L, De Ponti E, Buda A, Dolci C et al. 18F-FDG PET/CT can predict nodal metastases but not recurrence in early stage uterine cervical cancer. Gynecol Oncol, 2012; 127:131–135. 34. Lin Qiu, Yue Chen. Comparison between 18F-FDG PET (PET/CT) and sentinel lymph node biopsy in the detection of regional lymph node metastasis of various malignancies: review of the literature Journal of Biomedical Graphics and Computing, 2013; 3 (4): 101-115. 35. Jianjiang Ruan, Yueqiao Zhang, Hong Ren. Meta-analysis of PET/CT Detect Lymph Nodes Metastases of Cervical Cancer. Open Med (Wars), 2018; 13: 436–442.