Abstract
We aimed to explore the accuracy of 99mTc SPECT/MRI fusion for the
selective assessment of nonenlarged sentinel lymph nodes (SLNs) for
diagnosing metastases in early-stage cervical cancer patients. Methods:
We consecutively included stage IA1–IIB1 cervical cancer patients
who presented to our tertiary referral center between March
2011 and February 2015. Patients with enlarged lymph nodes (short
axis $ 10 mm) on MRI were excluded. Patients underwent an SLN
procedure with preoperative 99mTc-nanocolloid SPECT/CT-based
SLN mapping. When fused datasets of the SPECT and MR images
were created, SLNs could be identified on the MR image with accurate
correlation to the histologic result of each individual SLN. An
experienced radiologist, masked to histology, retrospectively
reviewed all fused SPECT/MR images and scored morphologic SLN
parameters on a standardized case report form. Logistic regression
and receiver-operating curves were used to model the parameters
against the SLN status. Results: In 75 cases, 136 SLNs were eligible
for analysis, of which 13 (9.6%) contained metastases (8 cases). Three
parameters—short-axis diameter, long-axis diameter, and absence of
sharp demarcation—significantly predicted metastatic invasion of nonenlarged
SLNs, with quality-adjusted odds ratios of 1.42 (95% confidence
interval [CI], 1.01–1.99), 1.28 (95% CI, 1.03–1.57), and 7.55 (95%
CI, 1.09–52.28), respectively. The area under the curve of the receiveroperating
curves combining these parameters was 0.749 (95% CI,
0.569–0.930). Heterogeneous gadolinium enhancement, cortical thickness,
round shape, or SLN size, compared with the nearest non-SLN,
showed no association with metastases (P 5 0.055–0.795). Conclusion:
In cervical cancer patients without enlarged lymph nodes, selective evaluation
of only the SLNs—for size and absence of sharp demarcation—
can be used to noninvasively assess the presence of metastases.
selective assessment of nonenlarged sentinel lymph nodes (SLNs) for
diagnosing metastases in early-stage cervical cancer patients. Methods:
We consecutively included stage IA1–IIB1 cervical cancer patients
who presented to our tertiary referral center between March
2011 and February 2015. Patients with enlarged lymph nodes (short
axis $ 10 mm) on MRI were excluded. Patients underwent an SLN
procedure with preoperative 99mTc-nanocolloid SPECT/CT-based
SLN mapping. When fused datasets of the SPECT and MR images
were created, SLNs could be identified on the MR image with accurate
correlation to the histologic result of each individual SLN. An
experienced radiologist, masked to histology, retrospectively
reviewed all fused SPECT/MR images and scored morphologic SLN
parameters on a standardized case report form. Logistic regression
and receiver-operating curves were used to model the parameters
against the SLN status. Results: In 75 cases, 136 SLNs were eligible
for analysis, of which 13 (9.6%) contained metastases (8 cases). Three
parameters—short-axis diameter, long-axis diameter, and absence of
sharp demarcation—significantly predicted metastatic invasion of nonenlarged
SLNs, with quality-adjusted odds ratios of 1.42 (95% confidence
interval [CI], 1.01–1.99), 1.28 (95% CI, 1.03–1.57), and 7.55 (95%
CI, 1.09–52.28), respectively. The area under the curve of the receiveroperating
curves combining these parameters was 0.749 (95% CI,
0.569–0.930). Heterogeneous gadolinium enhancement, cortical thickness,
round shape, or SLN size, compared with the nearest non-SLN,
showed no association with metastases (P 5 0.055–0.795). Conclusion:
In cervical cancer patients without enlarged lymph nodes, selective evaluation
of only the SLNs—for size and absence of sharp demarcation—
can be used to noninvasively assess the presence of metastases.
| Original language | English |
|---|---|
| Pages (from-to) | 551-556 |
| Journal | Journal of Nuclear Medicine |
| Volume | 57 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - 2016 |
Keywords
- cervical cancer
- sentinel lymph node
- metastasis
- SPECT/CT
- MRI