False negative rate at (18)F-FDG PET/CT in para-aortic lymphnode involvement in patients with locally advanced cervical cancer: impact of PET technology.

Affiliation

Gouy S(1)(2)(3), Seebacher V(1), Chargari C(2)(4)(5), Terroir M(6), Grimaldi S(6), Ilenko A(1), Maulard A(1), Genestie C(7), Leary A(8), Pautier P(8), Morice P(1)(2)(3), Deandreis D(9)(10).
Author information:
(1)Department of Gynecologic Surgery, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, Villejuif, France.
(2)University Paris Sud, Orsay, France.
(3)Unit INSERM 1030, 114 Rue Edouard Vaillant, Villejuif, France.
(4)Department of Radiotherapy and Brachytherapy Unit, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, Villejuif, France.
(5)Effets biologiques des rayonnements, Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France.
(6)Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
(7)Department of Pathology, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, Villejuif, France.
(8)Department of Medical Oncology, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, Villejuif, France.
(9)Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Paris Saclay, 114 Rue Edouard Vaillant, 94800, Villejuif, France. [Email]
(10)Department of Medical Sciences, Nuclear Medicine Division, the University of Turin, C.so Dogliotti, 14 10126, Turin, Italy. [Email]

Abstract

BACKGROUND: The identification of factors responsible for false negative (FN) rate at 18F- 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. METHODS: 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 18F-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. RESULTS: 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). CONCLUSIONS: 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.