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Tumour and pelvic lymph node metabolic activity on FDG-PET/CT to stratify patients for para-aortic surgical staging in locally advanced cervical cancer

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Abstract

Purpose

The aim of our study was to comprehensively evaluate the most valuable metabolic parameters of cervical tumours and pelvic lymph nodes (PLN) by FDG-PET/CT to predict para-aortic lymph node (PALN) metastasis and stratify patients for surgical staging.

Methods

The study included patients with locally advanced cervical cancer, negative PALN uptake on preoperative FDG-PET/CT, and para-aortic lymphadenectomy. Two senior nuclear medicine physicians expert in gynaecologic oncology reviewed all PET/CT exams, and extracted tumour SUVmax, MTV, and TLG, as well as PLN. Prognostic parameters of PALN involvement were identified using ROC curves and logistic regression analysis.

Results

One hundred and twenty-five consecutive locally advanced cervical cancer patients were included. The FDG-PET/CT false-negative rate was, respectively, 27.7% (13/47) and 5.1% (4/78) in patients with and without FDG-PET/CT PLN uptake. The AUC of cervical tumour size, SUVmax, MTV, and TLG was, respectively, 0.75 (0.62–0.87), 0.59 (0.44–0.76), 0.75 (0.60–0.90), and 0.71 (0.56–0.86). The AUC of PLN size, SUVmax, SUVmean, PLN SUVmax/Tumour SUVmax ratio, MTV, and TLG was, respectively, 0.57 (0.37–0.78), 0.82 (0.68–0.95), 0.77 (0.61–0.94), 0.85 (0.72–0.98), 0.69 (0.51–0.87), and 0.74 (0.57–0.91). The metabolic parameter showing the best trade-off between sensitivity and specificity to predict PALN involvement was the ratio between PLN and tumour SUVmax.

Conclusion

The risk of PALN metastasis in FDG-PET/CT negative PLN patients is very low, so para-aortic lymphadenectomy does not seem justified. In patients with preoperative PLN uptake on FDG-PET/CT, surgical staging led to treatment modification in more than 25% of cases and should therefore be performed. Patients with more than one positive PLN and high PLN metabolic activity are at high risk of para-aortic extension and recurrence. Further prospective evaluation is required to consider intensified treatment modalities without prior PALN dissection.

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Acknowledgements

Martina Aida Angeles acknowledges grant support from “La Caixa” Foundation, Barcelona, Spain. We would also like to thank Dr. Gail Taillefer, a native English speaker experienced in scientific publication, for her review of the manuscript.

Author information

Authors and Affiliations

  1. Surgical Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer –Toulouse Oncopole, Toulouse, France

    A. Martinez, M. Voglimacci, N. Dupuis, M. A. Angeles, C. Martinez & G. Ferron

  2. Cancer Research Center of Toulouse (CRCT), INSERM UMR, 1037, Toulouse, France

    A. Martinez, C. Martinez & G. Ferron

  3. Biostatistics Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France

    A. Lusque

  4. Radiotherapy Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France

    A. Ducassou

  5. Medical Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France

    L. Gladieff

  6. Gynecology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France

    Y. Tanguy Le Gac & E. Chantalat

  7. Nuclear Medicine Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France

    A. Hitzel

  8. Nuclear Medicine Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France

    F. Courbon & E. Gabiache

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  1. A. Martinez
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  2. M. Voglimacci
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Correspondence to A. Martinez.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Martinez, A., Voglimacci, M., Lusque, A. et al. Tumour and pelvic lymph node metabolic activity on FDG-PET/CT to stratify patients for para-aortic surgical staging in locally advanced cervical cancer. Eur J Nucl Med Mol Imaging 47, 1252–1260 (2020). https://doi.org/10.1007/s00259-019-04659-z

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