Retrospective comparison of lymp node position in pre-operational PET/CT and mri imaging and lymph node metastasis detected in post-operational pathology results in uterine cervical cancer

OBJECTIVE: Cervical cancer is the fourth most commonly diagnosed cancer, with an estimated 604,000 new cases and 342,000 deaths worldwide in 2020. In recent years, the availability of effective screening of cervical neoplasms, recognition treatment of precancerous lesions, and access to early diagnosis, effective treatment for invasive cancer have resulted in a reduction in cervical cancer incidence and mortality in most regions of the world. The most important prognostic factors in cervical cancer are stage and lymph node involvement that. If 100 fertility preservation is not desired in early stage cervical cancers, the standard treatment choice is simple/radical hysterectomy with pelvic/paraaortic lymphadenectomy for required cases. Stage and tumor size are important in whether hysterectomy is radical or not. However, primary chemoradiation may be considered for patients with low fitness who cannot undergo surgery. In patients with early stage cervical cancer with moderate risk factors, adjuvant radiotherapy or adjuvant chemoradiation can be given. If any of the high-grade risk factors are present, adjuvant chemoradiation is recommended. NCCN recommends PET/CT to detect lymph node and distant metastases before deciding on chemoradiation of locally advanced cervical cancer. Analyzing data from studies GOG 85, GOG 120, and GOG 165, Gold et al. found progression-free survival (50% vs. 36%) and overall survival (54% vs. 40%) in favor of surgical staging. Patients must be carefully evaluated from beginning to end in order to be able to manage them appropriately and to determine the most effective treatment method. In order not to increase the morbidity and mortality of the patients, staging, which is the most important prognostic factor, is to be done carefully. For this purpose, we planned a retrospective study to investigate the performance of imaging methods (PET/CT, MRI) in demonstrating lymph node metastases. MATERIAL AND METHOD: Patients who underwent pelvic and/or paraaortic lymph node dissection and had at least one imaging method (MRI, PET/CT ) recorded in the hospital electronic file system evaluated and followed by Akdeniz University Faculty of Medicine, Department of Gynecological Oncology Surgery or Department of Medical Oncology were included in the study. 139 patients were included in this study. Lymph node metastasis in the histopathological reports of these patients was accepted as the gold standard. The presence of lymph nodes in imaging methods (PET/CT and MRI) was considered positive and compared with pathological lymph node metastasis, which is the gold standard. Thus, the accuracy, specificity, sensitivity, PPD, and NPD of imaging methods in predicting lymph node metastasis were calculated. RESULTS: The majority of patients (n:32, 23%) are FIGO stage 3C1P. This is followed by the FIGO 1B2 group (n:31, 22.3%). Histologically lymph node involvement was detected in 29.5% of the patients, histologically no lymph node 101 involvement was detected in 70.5% of the patients. Pelvic lymph node involvement was found in 33 (23.7%) of 139 patients, paraaortic lymph node involvement in 3 (2.2%) and pelvic and paraaortic lymph node involvement in 5 (3.6%) patients. While 56.1% of the patients had lymph node involvement in MRI imaging, 43.9% did not have lymph node involvement in MRI imaging. While lymph node involvement was detected in PET/CT in 38.1% of the patients, it was not detected in 61.9% of the patients. In the histopathological evaluation of the patients, squamous cell carcinoma (72.6%) was the most common type and adenocarcinoma (23%) was the second most common. While 54% of the patients are in the early stage, 56% are in the advanced stage. The number of patients with lymph node involvement in MRI was 61 (56.1%), and histopathologically, lymph node involvement was reported in 25 (61%) of them. The number of patients with lymph node involvement in PET CT was 53 (38.1%), and histopathologically, lymph node involvement was reported in 29 (70.7%) of them. The sensitivity, specificity, positive and negative predictive value and accuracy of PET/CT in predicting metastatic lymph node are 70.7%, 75.5%, 54.7%, 86% and 74.1%, respectively. The sensitivity, specificity, positive and negative predictive value and accuracy of MRI in detecting metastatic lymph node are 60.9%, 63.2%, 40.9%, 79.4%, 62.5%, respectively. CONCLUSION: In the light of the data obtained, it is very important to determine the lymph node metastases by imaging methods, and guide the treatment in determining the treatment management in cervical cancer, especially when choosing the surgical method and before performing pelvic-paraaortic lymphadenectomy. KEY WORDS: PET/CT, MR, CT, Lymphadenectomy, Cervical Cancer, Preoperative Screening, lymph node metastasis