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Histologic Results of Para-Aortic Lymphadenectomy in Patients Treated for Stage IB2/II Cervical Cancer With Negative [¹⁸F]Fluorodeoxyglucose Positron Emission Tomography Scans in the Para-Aortic Area

Mathias Boughanim, Sophie Leboulleux, Annie Rey, Chi Tuan Pham, Yaelle Zafrani, Pierre Duvillard, Jean Lumbroso, Christine Haie-Meder, Martin Schlumberger, Philippe Morice

From the Departments of Surgery, Nuclear Medicine, Statistics, Pathology, and Radiation Therapy, Institut Gustave Roussy, and University Paris Sud, Villejuif, France

Corresponding author: Philippe Morice, MD, Service de Chirurgie, Institut Gustave Roussy and University Paris Sud, 39 rue Camille Desmoulins, 94805 Villejuif Cedex, France; e-mail: morice{at}igr.fr

Purpose Histologic results of complete para-aortic lymphadenectomy were studied in patients treated for stage IB2/II cervical carcinoma who had no para-aortic uptake on [¹⁸F]fluorodeoxyglucose positron emission tomography combined with integrated computed tomography (FDG-PET/CT).

Patients and Methods Patients were treated between 2004 and 2006 for stage IB2/II cervical cancer. Magnetic resonance imaging of the abdomen and pelvis and FDG-PET/CT were initially performed. Patients with no para-aortic abnormalities were treated with external pelvic radiation therapy and concomitant chemotherapy followed by utero-vaginal brachytherapy. Para-aortic lymphadenectomy was then performed. FDG-PET/CT images were reviewed by two nuclear medicine specialists.

Results Thirty-eight patients were studied. Three patients had histologically proven para-aortic involvement (metastatic nodes with capsular rupture in the para-aortic area), leading to a negative predictive value of 92% for para-aortic nodal involvement.

Conclusion In this study, three of 38 patients with no para-aortic uptake on [¹⁸F]FDG-PET/CT imaging had histologically proven para-aortic node involvement. PET/CT imaging without histologic examination of the para-aortic area used to determine radiation therapy fields in stage IB2/II cervical cancer would overlook 8% of patients with histologic para-aortic nodal involvement.

Presented at the 39th Annual Meeting of the Society of Gynecologic Oncology, March 9-12, 2008, Tampa, FL.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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