PET/CT dilemma in para-aortic lymph node assessment in locally advanced cervical cancer?

INTRODUCTION: 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.