Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, People's Republic of China.
BMC Cancer. 2021 Feb 27;21(1):203. doi: 10.1186/s12885-021-07890-w.
The 2018 International Federation of Gynecology and Obstetrics (FIGO) staging guideline for cervical cancer includes stage IIIC recognized by preoperative radiology (IIIC-r) to state there are lymph nodes metastases (LNM) identified by imaging tools. We aim to explore the reasonability and limitations of stage IIIC-r and try to explore the potential reasons.
Electronic medical records were used to identify patients with cervical cancer. According to the new staging guidelines, patients were reclassified and assigned into five cohorts: stage I, stage II, stage IIIC-r, LNM confirmed by pathology (IIIC-p) and LNM detected by radiology and confirmed by pathology (IIIC r + p). Five-year overall survivals were estimated for each cohort. The diagnosis accuracy of computed tomography (CT), magnetic resonance imaging (MRI) and diameter of detected lymph nodes were also evaluated.
A total of 619 patients were identified. The mean follow-up months were 65 months (95% CI 64.43-65.77) for all patients. By comparison, the 5-year overall survival rates were not statistically different (p = 0.21) among stage IIIC-r, stage I and stage II. While, the rates were both statistical different (p<0.001) among stage IIIC-p, IIIC r + p and stage I and stage II. The sensitivities of CT and MRI in detecting LNM preoperatively were 51.2 and 48.8%. The mean maximum diameter of pelvic lymph nodes detected by CT cohort was 1.2 cm in IIIC-r cohort, and was 1.3 cm in IIIC r + p cohort. While, the mean maximum diameter of pelvic lymph nodes detected by MRI was 1.2 cm in IIIC-r cohort, and was 1.48 cm in IIIC r + p cohort. When the diagnosis efficacy of the diameter of pelvic lymph nodes in detecting LNM were evaluated, the area under the receiver operating characteristic curve (ROC curve) was 0.58 (p = 0.05).
It seems that the FIGO 2018 staging guideline for cervical cancer is likely to has certain limitations for the classification of those with LNM. CT or MRI, however, has limitations on detecting LNM. It would be better to use more accurate imaging tools to identify LNM in the clinical practices.
2018 年国际妇产科联合会（FIGO）宫颈癌分期指南包括术前影像学检查（IIIC-r）确认的 IIIC 期，以表明存在影像学工具识别的淋巴结转移（LNM）。我们旨在探讨 IIIC-r 的合理性和局限性，并尝试探讨潜在原因。
使用电子病历识别宫颈癌患者。根据新的分期指南，将患者重新分类并分为五组：I 期、II 期、IIIC-r 期、经病理证实的 LNM（IIIC-p）和经影像学和病理证实的 LNM（IIIC r+p）。为每个队列估计了 5 年总生存率。还评估了计算机断层扫描（CT）、磁共振成像（MRI）和检测到的淋巴结直径的诊断准确性。
共确定了 619 名患者。所有患者的中位随访时间为 65 个月（95%CI 64.43-65.77）。相比之下，IIIC-r、I 期和 II 期的 5 年总生存率无统计学差异（p=0.21）。然而，IIIC-p、IIIC r+p 和 I 期和 II 期之间的生存率均有统计学差异（p<0.001）。CT 和 MRI 术前检测 LNM 的灵敏度分别为 51.2%和 48.8%。在 IIIC-r 队列中，CT 检测到的盆腔淋巴结的平均最大直径为 1.2cm，在 IIIC r+p 队列中为 1.3cm。而在 IIIC-r 队列中，MRI 检测到的盆腔淋巴结的平均最大直径为 1.2cm，在 IIIC r+p 队列中为 1.48cm。当评估盆腔淋巴结直径对检测 LNM 的诊断效果时，受试者工作特征曲线（ROC 曲线）下面积为 0.58（p=0.05）。
FIGO 2018 年宫颈癌分期指南似乎对 LNM 患者的分类存在一定局限性。然而，CT 或 MRI 在检测 LNM 方面存在局限性。在临床实践中，最好使用更准确的成像工具来识别 LNM。
