Role of integrated PET-CT in pelvic lymph node staging of cervical cancer before radical hysterectomy

Abstract

BACKGROUND: To investigate the feasibility of preoperative integrated positron emission tomography-computed tomography (PET-CT) with fluoro-2-deoxy-D-glucose (FDG) in primary pelvic lymph node (LN) staging before radical hysterectomy (RH) and pelvic lymphadenectomy (PLND) in cervical cancer. METHODS: We reviewed medical records of all patients with FIGO stage IA2-IIB cervical cancer who underwent a preoperative FDG PET-CT and underwent type II or III RH and PLND between January 1, 2003, and July 31, 2007. RESULTS: A total of 34 patients underwent preoperative PET-CT scans followed by RH and PLND during the study period. Of the 34 patients, 17 (50.0%) had pelvic LN metastases, and the median number of harvested LNs was 29 (range 13-57). The overall region-specific sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PET-CT were 36.4, 98.8, 85.7, 88.9, and 88.7%, respectively. The patients with positive preoperative PET-CT scans showed higher recurrence rates (3/8) than those with negative scans (1/26); the difference was statistically significant (p = 0.031). CONCLUSION: Integrated PET-CT scan has limited sensitivity, but high specificity for predicting pelvic LN metastasis in preoperative staging of invasive cervical cancer. Furthermore, preoperative integrated PET-CT may be a useful tool for identifying patients with higher risk of cervical cancer recurrence.