Department of Gynecologic Surgery, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, Villejuif, France.
University Paris Sud, Orsay, France.
BMC Cancer. 2021 Feb 6;21(1):135. doi: 10.1186/s12885-021-07821-9.
The identification of factors responsible for false negative (FN) rate at F- Fluorodeoxyglucose (FDG) Positron Emission Tomography /Computed Tomography (PET/CT) in para-aortic (PA) lymph nodes in the presurgical staging of patients with locally advanced cervical cancer (LACC) is challenging. The aim of this study was to evaluate the impact of PET/CT technology.
A total of 240 consecutive patients with LACC (International Federation of Gynecology and Obstetrics, FIGO, stage IB2-IVA) and negative Magnetic Resonance Imaging (MRI) and/or Computed Tomography (CT) and negative F-FDG PET/CT in the PA region, undergoing laparoscopic PA lymphadenectomy before chemoradiotherapy were included. The FN rate in patients studied with Time of flight (TOF) PET/CT (TOF PET) or non-Time of flight PET/CT (no-TOF PET) technology was retrospectively compared.
Patients presented with FIGO stage IB (n = 78), stage IIA-B (n = 134), stage III (n = 18) and stage IVa (n = 10), squamous cell carcinoma (n = 191) and adenocarcinoma (n = 49). 141/240 patients were evaluated with no-TOF PET/CT and 99/240 with TOF PET/CT. Twenty-two patients (9%) had PA nodal involvement at histological analysis and considered PET/CT FN findings. The FN rate was 8.5% for no-TOF PET and 10% for TOF PET subgroup respectively (p = 0.98). Ninety patients (38%) presented with pelvic node uptakes at PET/CT. The FN rate in the PA region was 18% (16/90) and 4% (6/150) in patients with and without pelvic node involvement at PET/CT respectively (19 vs 3% for no-TOF PET and 17 vs 5% for TOF PET subgroup).
In LACC, FN rate in PA lymph nodes detection is a clinical issue even for modern PET/CT, especially in patients with pelvic uptake. Surgical lymphadenectomy should be performed in case of negative PET/CT at PA level in these patients, while it could be discussed in the absence of pelvic uptake.
在局部晚期宫颈癌（LACC）患者的术前分期中，氟-18 氟代脱氧葡萄糖（FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）在主动脉旁（PA）淋巴结中出现假阴性（FN）率的原因难以确定。本研究的目的是评估 PET/CT 技术的影响。
共纳入 240 例连续局部晚期宫颈癌（国际妇产科联合会，FIGO，IB2-IVA 期）患者，MRI 和/或 CT 及 F-FDG PET/CT 检查阴性，且行腹腔镜下 PA 淋巴结清扫术，随后行放化疗。回顾性比较采用飞行时间（TOF）PET/CT（TOF PET）或非飞行时间 PET/CT（no-TOF PET）技术的患者的 FN 率。
患者的 FIGO 分期为 IB（n=78）、IIA-B（n=134）、III（n=18）和 IVa（n=10），鳞癌（n=191）和腺癌（n=49）。240 例患者中，141 例行 no-TOF PET/CT 检查，99 例行 TOF PET/CT 检查。22 例（9%）患者在组织学分析时发现 PA 淋巴结受累，认为是 PET/CT 的 FN 发现。no-TOF PET 和 TOF PET 亚组的 FN 率分别为 8.5%和 10%（p=0.98）。90 例（38%）患者 PET/CT 显示盆腔淋巴结摄取。PA 区的 FN 率在 PET/CT 显示有盆腔淋巴结受累的患者中为 18%（16/90），在无盆腔淋巴结受累的患者中为 4%（6/150）（no-TOF PET 为 19%，TOF PET 为 5%）。
即使是现代的 PET/CT，在 LACC 中，PA 淋巴结检测的 FN 率也是一个临床问题，尤其是在有盆腔摄取的患者中。在这些患者中，如果 PET/CT 显示 PA 水平阴性，应行外科淋巴结清扫术，而如果没有盆腔摄取，则可进行讨论。
