Metastatic lymph nodes in patients with cervical cancer: detection with MR imaging and FDG PET.

PURPOSE To compare the diagnostic accuracy of magnetic resonance (MR) imaging with that of positron emission tomography (PET) with 2-[fluorine 18]fluoro-2-deoxy-D-glucose (FDG) for detecting metastatic lymph nodes in patients with cervical cancer. MATERIALS AND METHODS Before radical hysterectomy and pelvic lymphadenectomy in 35 patients with International Federation of Gynecology and Obstetrics stage IB or II cervical cancer, abdominal FDG-PET and MR imaging were performed. Malignancy criteria were a lymph node diameter of 1 cm or more at MR imaging and a focally increased FDG uptake at PET. The findings of FDG-PET and MR imaging were compared with histologic findings. RESULTS Histologic examination revealed pN0-stage cancer in 24 patients and pN1-stage cancer in 11 patients. On a patient basis, node staging resulted in sensitivities of 0.91 with FDG-PET and 0.73 with MR imaging and specificities of 1.00 with FDG-PET and 0.83 with MR imaging. The positive predictive value (PPV) of FDG-PET was 1.00 and that of MR imaging, 0.67 (not significant). The metastatic involvement of lymph node sites was identified at FDG-PET with a PPV of 0.90; at MR imaging, 0.64 (P <.05, Fisher exact test). CONCLUSION Metabolic imaging with FDG-PET is an alternative to morphologic MR imaging for detecting metastatic lymph nodes in patients with cervical cancer.

[1]  Detection of lymph-node metastases in patients with gastric carcinoma: comparison of three MR imaging pulse sequences , 2011, Abdominal Imaging.

[2]  R. Weissleder,et al.  Ultrasmall superparamagnetic iron oxide: an intravenous contrast agent for assessing lymph nodes with MR imaging. , 1990, Radiology.

[3]  B. I. Choi,et al.  Uterine cervical carcinoma: evaluation of pelvic lymph node metastasis with MR imaging. , 1994, Radiology.

[4]  R L Wahl,et al.  To AC or not to AC: that is the question. , 1999, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[5]  E Abemayor,et al.  Positron emission tomography: A new, precise imaging modality for detection of primary head and neck tumors and assessment of cervical adenopathy , 1992, The Laryngoscope.

[6]  G. K. Mulholland,et al.  Simple rapid hydrolysis of acetyl protecting groups in the FDG synthesis using cation exchange resins. , 1995, Nuclear medicine and biology.

[7]  T. Inoue,et al.  Prognostic significance of parametrial extension in patients with cervical carcinoma stages IB, IIA, and IIB. A study of 628 cases treated by radical hysterectomy and lymphadenectomy with or without postoperative irradiation , 1984, Cancer.

[8]  H. Nakano,et al.  Multivariate analysis of the histopathologic prognostic factors of cervical cancer in patients undergoing radical hysterectomy , 1992, Cancer.

[9]  K. Kjørstad,et al.  The value of complete lymphadenectomy in radical treatment of cancer of the cervix, stage IB , 1984, Cancer.

[10]  S. Chow,et al.  Prognostic factors of primary adenocarcinoma of the uterine cervix. , 1998, Gynecologic oncology.

[11]  T. Inoue,et al.  Prognostic factors of adenocarcinoma of the uterine cervix. , 1999, Gynecologic oncology.

[12]  W. A. Little,et al.  Radical hysterectomy for invasive cervical cancer: A 25‐year prospective experience with the Miami technique , 1993, Cancer.

[13]  J. Han,et al.  Preoperative Staging of Uterine Cervical Carcinoma: Comparison of CT and MRI in 99 Patients , 1993, Journal of computer assisted tomography.

[14]  K. Ng,et al.  Preoperative prognostic variables and the impact of postoperative adjuvant therapy on the outcomes of stage IB or II cervical carcinoma patients with or without pelvic lymph node metastases , 1999, Cancer.

[15]  M. Piver,et al.  Five Classes of Extended Hysterectomy for Women With Cervical Cancer , 1974, Obstetrics and gynecology.

[16]  T. Kaku,et al.  Histopathological factors influencing pelvic lymph node metastases in two ormore sites in patients with cervical carcinoma undergoing radical hysterectomy , 1999, Acta obstetricia et gynecologica Scandinavica.

[17]  D. Delbeke,et al.  Evaluation of pulmonary lesions with FDG-PET. Comparison of findings in patients with and without a history of prior malignancy. , 1996, Chest.

[18]  T. Inoue,et al.  The prognostic significance of number of positive nodes in cervical carcinoma stages IB, IIA, and IIB , 1990, Cancer.

[19]  J. Haas,et al.  The importance of the histologic processing of pelvic lymph nodes in the treatment of cervical cancer , 1992, International Journal of Gynecologic Cancer.

[20]  R. Weissleder,et al.  Lymph nodes: microstructural anatomy at MR imaging. , 1991, Radiology.

[21]  R Weissleder,et al.  Experimental lymph node metastases: enhanced detection with MR lymphography. , 1989, Radiology.

[22]  L. Adler,et al.  Positron emission tomography for evaluating para-aortic nodal metastasis in locally advanced cervical cancer before surgical staging: a surgicopathologic study. , 1999, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[23]  J. Wiener,et al.  Breast and axillary tissue MR imaging: correlation of signal intensities and relaxation times with pathologic findings. , 1986, Radiology.

[24]  R L Wahl,et al.  Evaluation of FDG PET in patients with cervical cancer. , 1999, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[25]  N. Sakuragi,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 , 1999, Cancer.

[26]  M R Segal,et al.  Radiological evaluation of lymph node metastases in patients with cervical cancer. A meta-analysis. , 1997, JAMA.

[27]  S. Schoenberg,et al.  Staging of invasive cervical carcinoma and of pelvic lymph nodes by high resolution MRI with a phased-array coil in comparison with pathological findings. , 1998, Journal of computer assisted tomography.

[28]  D M Parkin,et al.  Estimates of the worldwide frequency of sixteen major cancers in 1980 , 1988, International journal of cancer.

[29]  V. Devita,et al.  Cancer : Principles and Practice of Oncology , 1982 .

[30]  L. Adler,et al.  Technical improvements in fluorine-18-FDG PET imaging of the abdomen and pelvis. , 1997, Journal of nuclear medicine technology.

[31]  K. Hatch,et al.  Rationale for using pathologic tumor dimensions and nodal status to subclassify surgically treated stage IB cervical cancer patients. , 1991, Gynecologic oncology.

[32]  E. Nitzsche,et al.  Combined FDG and [F-18]fluoride whole-body PET: a feasible two-in-one approach to cancer imaging? , 1998, Radiology.

[33]  B. Sevin,et al.  Prospective surgical-pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. , 1990, Gynecologic oncology.

[34]  H. Malcolm Hudson,et al.  Accelerated image reconstruction using ordered subsets of projection data , 1994, IEEE Trans. Medical Imaging.

[35]  B N Bundy,et al.  Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. , 1999, The New England journal of medicine.