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CC BY-NC-ND 4.0 · World J Nucl Med 2020; 19(03): 240-245
DOI: 10.4103/wjnm.WJNM_74_19
Original Article

Diagnostic value of sentinel lymph node scintigraphy and 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography in the detection of metastatic lymph nodes in patients with early-stage cervical cancer

Florette Reyneke
Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria
,
Leon Snyman
1   Department of Obstetrics and Gynaecology, University of Pretoria and Kalafong Hospital, Pretoria, South Africa
,
Ismaheel Lawal
Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria
,
Thabo Lengana
Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria
,
Mariza Vorster
Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria
,
Mike Sathekge
Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria
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Abstract

Cervical cancer is staged clinically using the International Federation of Gynaecology and Obstetrics staging system. Although lymph node status does not form part of the staging, it has important prognostic and potential therapeutic implications. The aim of the study was to evaluate the role of sentinel lymph node (SLN) scintigraphy and 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) in detecting lymph node metastases in patients with early-stage cervical cancer. Thirty-six patients with early-stage cervical cancer underwent SLN detection during primary operation. Of the 36 patients, 28 patients underwent 18F-FDG PET/CT before surgery. The 18F-FDG PET/CT images were analyzed with the histopathological findings as the reference standard. The diagnostic performance of 18F-FDG PET/CT in the detection of nodal disease was reported in terms of accuracy value. The SLN detection rate was the highest (91.7%) using the combined method (lymphoscintigraphy, intraoperative gamma probe, and blue dye). Seven of the thirty-six patients had lymph node involvement (19.4%), of which five had preoperative 18F-FDG PET/CT imaging. On overall patient-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of 18F-FDG PET/CT were 40.0%, 78.3%, 28.6%, 85.7%, and 71.4%, respectively. The combination of radiolabeled nanocolloid with blue dye is safe and reliable and allows successful detection of SLNs in patients with early-stage cervical cancer in a population with high prevalence of human immunodeficiency virus. The specificity and NPV of 18F-FDG PET/CT are high and can be used in conjunction with SLN biopsy.

Keywords

2-[18F]-fluoro-2-deoxy-D-glucose - cervical cancer - positron emission tomography/computed tomography - sentinel lymph node

Financial support and sponsorship

Nil.




Publication History

Received: 03 October 2019

Accepted: 07 November 2019

Article published online:
19 April 2022

© 2020. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser M, Mathers C, et al. GLOBOCAN 2012 cancer incidence and mortality worldwide: IARC CancerBase No. 11. Lyon: International Agency for Research on Cancer; 2013.
  • 2 Statistics South Africa. Mid-Year Population Estimates, 2018. Stats SA; 23 July, 2018. Available from: http://www.statssa.gov.za/publications/P0302/P03022018.pdf. [Last accessed on 2018 Dec 10].
  • 3 Hawes SE, Critchlow CW, Faye NiangMA, Diouf MB, Diop A, Touré P, et al. Increased risk of high-grade cervical squamous intraepithelial lesions and invasive cervical cancer among african women with human immunodeficiency virus type 1 and 2 infections. J Infect Dis 2003;188:555-63.
  • 4 Delmas MC, Larsen C, van BenthemB, Hamers FF, Bergeron C, Poveda JD, et al. Cervical squamous intraepithelial lesions in HIV-infected women: Prevalence, incidence and regression. European study group on natural history of HIV infection in women. AIDS 2000;14:1775-84.
  • 5 La RucheG, You B, Mensah-Ado I, Bergeron C, Montcho C, Ramon R, et al. Human papillomavirus and human immunodeficiency virus infections: Relation with cervical dysplasia-neoplasia in african women. Int J Cancer 1998;76:480-6.
  • 6 Pecorelli S, Zigliani L, Odicino F. Revised FIGO staging for carcinoma of the cervix. Int J Gynaecol Obstet 2009;105:107-8.
  • 7 Sevin BU, Lu Y, Bloch DA, Nadji M, Koechli OR, Averette HE. Surgically defined prognostic parameters in patients with early cervical carcinoma. A multivariate survival tree analysis. Cancer 1996;78:1438-46.
  • 8 Matsuura Y, Kawagoe T, Toki N, Tanaka M, Kashimura M. Long-standing complications after treatment for cancer of the uterine cervix — Clinical significance of medical examination at 5 years after treatment. Int J Gynecol Cancer 2006;16:294-7.
  • 9 Achouri A, Huchon C, Bats AS, Bensaid C, Nos C, Lécuru F. Complications of lymphadenectomy for gynecologic cancer. Eur J Surg Oncol 2013;39:81-6.
  • 10 Look KY, Brunetto VL, Clarke-Pearson DL, Averette HE, Major FJ, Alvarez RD, et al. An analysis of cell type in patients with surgically staged stage IB carcinoma of the cervix: A Gynecologic oncology group study. Gynecol Oncol 1996;63:304-11.
  • 11 Cabanas RM. An approach for the treatment of penile carcinoma. Cancer 1977;39:456-66.
  • 12 Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992;127:392-9.
  • 13 Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 1994;220:391-8.
  • 14 Reinhardt MJ, Ehritt-Braun C, Vogelgesang D, Ihling C, Högerle S, Mix M, et al. Metastatic lymph nodes in patients with cervical cancer: Detection with MR imaging and FDG PET. Radiology 2001;218:776-82.
  • 15 Matsukuma K, Tsukamoto N, Matsuyama T, Ono M, Nakano H. Preoperative CT study of lymph nodes in cervical cancer — Its correlation with histological findings. Gynecol Oncol 1989;33:168-71.
  • 16 Altgassen C, Hertel H, Brandstädt A, Köhler C, Dürst M, Schneider A. Multicenter validation study of the sentinel lymph node concept in cervical cancer: AGO study group. J Clin Oncol 2008;26:2943-51.
  • 17 Cormier B, Diaz JP, Shih K, Sampson RM, Sonoda Y, Park KJ, et al. Establishing a sentinel lymph node mapping algorithm for the treatment of early cervical cancer. Gynecol Oncol 2011;122:275-80.
  • 18 Lécuru F, Mathevet P, Querleu D, Leblanc E, Morice P, Daraï E, et al. Bilateral negative sentinel nodes accurately predict absence of lymph node metastasis in early cervical cancer: Results of the SENTICOL study. J Clin Oncol 2011;29:1686-91.
  • 19 Yuan SH, Xiong Y, Wei M, Yan XJ, Zhang HZ, Zeng YX, et al. Sentinel lymph node detection using methylene blue in patients with early stage cervical cancer. Gynecol Oncol 2007;106:147-52.
  • 20 Signorelli M, Guerra L, Montanelli L, Crivellaro C, Buda A, Dell'Anna T, et al. Preoperative staging of cervical cancer: Is 18-FDG-PET/CT really effective in patients with early stage disease? Gynecol Oncol 2011;123:236-40.
  • 21 Chou HH, Chang TC, Yen TC, Ng KK, Hsueh S, Ma SY, et al. Low value of [18F]-fluoro-2-deoxy-D-glucose positron emission tomography in primary staging of early-stage cervical cancer before radical hysterectomy. J Clin Oncol 2006;24:123-8.
  • 22 Wright JD, Dehdashti F, Herzog TJ, Mutch DG, Huettner PC, Rader JS, et al. Preoperative lymph node staging of early-stage cervical carcinoma by [18F]-fluoro-2-deoxy-D-glucose-positron emission tomography. Cancer 2005;104:2484-91.