Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston 77030, USA.
Int J Gynecol Cancer. 2012 Sep;22(7):1203-7. doi: 10.1097/IGC.0b013e31825e523a.
Pathologic evaluation of aortocaval nodes in patients with locally advanced cervical cancer in an effort to better tailor radiotherapy has gained popularity. We sought to determine which aortocaval nodes should be sampled during surgical staging procedures.
From 2004 to 2011, 246 patients with locally advanced cervical cancer underwent positron emission tomography (PET) before definitive chemoradiation. We reviewed the imaging studies to determine the location of PET-positive aortocaval nodes in relationship to the inferior mesenteric artery (IMA).
Forty-two patients (17%) had PET images suggesting aortocaval metastasis. Ten patients had stage IB, 1 had stage IIA, 13 had stage IIB, 13 had stage IIIB, and 5 had stage IV disease. Of these 42 patients, 39 (93%) had FDG-avid pelvic nodes, 1 (2%) had PET-negative pelvic nodes but FDG-avid common iliac nodes, and 2 (5%) had direct spread to the aortocaval nodes. Three patients (7%) had FDG-avid aortocaval nodes above the IMA without FDG-avid nodes between the aortic bifurcation and IMA. All 3 of these patients also had FDG-avid nodes in the pelvis. Nineteen patients (45%) had FDG-avid nodes above and below the IMA, and 20 (48%) had FDG-avid nodes below the IMA only.
This hypothesis-generating study revealed that a small number of patients have PET-positive aortocaval nodes above the IMA only. For patients undergoing surgical staging for locally advanced cervical cancer, dissection to the renal vessels may be necessary. A future international, randomized study will prospectively evaluate the locations of pathologically positive aortocaval lymph nodes.
对局部晚期宫颈癌患者的腹主动脉旁淋巴结进行病理评估，以更好地调整放疗方案，这种方法已经得到广泛应用。本研究旨在确定在外科分期手术中应取样的腹主动脉旁淋巴结。
2004 年至 2011 年，246 例局部晚期宫颈癌患者在接受根治性放化疗前进行正电子发射断层扫描（PET）检查。我们回顾了影像学检查结果，以确定 PET 阳性腹主动脉旁淋巴结与肠系膜下动脉（IMA）的位置关系。
42 例（17%）患者的 PET 图像提示腹主动脉旁转移。10 例为 IB 期，1 例为 IIA 期，13 例为 IIB 期，13 例为 IIIB 期，5 例为 IV 期。这些患者中，39 例（93%）有 FDG 摄取的盆腔淋巴结，1 例（2%）有 FDG 摄取阴性的盆腔淋巴结但有 FDG 摄取的髂总淋巴结，2 例（5%）有直接蔓延至腹主动脉旁淋巴结。3 例（7%）患者腹主动脉旁淋巴结位于 IMA 上方且 FDG 摄取阳性，而在主动脉分叉和 IMA 之间没有 FDG 摄取阳性的淋巴结。这 3 例患者的盆腔均有 FDG 摄取阳性的淋巴结。19 例（45%）患者的腹主动脉旁淋巴结在 IMA 上方和下方均有 FDG 摄取阳性，20 例（48%）患者仅在 IMA 下方有 FDG 摄取阳性的淋巴结。
本研究结果表明，少数患者仅有 IMA 上方的 PET 阳性腹主动脉旁淋巴结。对于接受局部晚期宫颈癌外科分期的患者，可能需要进行肾血管解剖。未来的国际随机研究将前瞻性评估病理阳性腹主动脉旁淋巴结的位置。
