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PET/CT dilemma in para-aortic lymph node assessment in locally advanced cervical cancer?
Mehmet Sait Bakır, Özer Birge, Ceyda Karadağ, Hasan Aykut Tuncer, Selen Doğan, Tayup ŞimşekDivision of Gynecologic Oncology, Department of Gynecology Obstetrics, Akdeniz University, Antalya, TurkeyINTRODUCTION: We aimed to discuss the relationship between the maximum standardized uptake value (SUVmax), which is the degree of involvement obtained in the radiopharmaceutical 18-Fluor-labeled glucose-utilized positron emission tomography-computed tomography (PET-CT), which is widely used in locally advanced cervical cancer, and para-aortic lymph node positivity as a result of histopathology in the light of the literature.
METHODS: The pre-operative PET-CT results of 66 patients who had been examined and treated for locally advanced (Stage IB3-IVA) cervical cancer between 2015 and 2020 were retrospectively examined and the relationship between the SUVmax values and para-aortic lymph node positivity in the histopathology results was evaluated. Patients with SUVmax 4≤ in PET-CT were accepted to have paraaortic lymph node involvement. In terms of para-aortic lymph involvement, a cross tabulation was created with PET-CT results and the final pathology, which is the gold standard, and the sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) were calculated.
RESULTS: The mean age of 66 patients included in our study was 48.2±13.2 years. The majority of our patients were at stage 1B3 (36.4%), while eight were at stage 3C2P. While para-aortic evaluation was performed through the laparoscopic method in 36 (54.5%) patients, it was performed by laparotomy in the remaining 30 (45.5%) patients. When the complaints of the patients were assessed, it was seen that the highest rate was that of post-coital bleeding in 32 patients (48.5%) and pelvic pain was observed in two patients (3%). The mean body mass index (BMI) was 22.69±4.14 and the squamous type was the most common in 44 patients (66.7%) in terms of histopathological typing. When we evaluated the results of 66 patients, the prevalence rate was around 12% and when we compared the SUVmax uptake rates found in PET-CT, which we used as a new diagnostic test with the pathology results, which is our gold standard test, the sensitivity and specificity rates were 50% and 48%, respectively. The PPV, the NPV, and accuracy were calculated as 11.7%, 87.5%, and 48.8%, respectively.
DISCUSSION AND CONCLUSION: Considering the high risk of para-aortic lymph node metastasis in locally advanced cervical cancer through assessment of the high SUVmax values in PETCT, it is necessary to confirm the status of the para-aortic lymph node with minimally invasive surgery in the foreground by experienced surgeons.
Manuscript Language: English
