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Delayed 18F-FDG PET for Detection of Paraaortic Lymph Node Metastases in Cervical Cancer Patients

Shih-Ya Ma, MD1, Lai-Chu See, PhD2, Chyong-Huey Lai, MD3, Hung-Hsueh Chou, MD3, Chien-Sheng Tsai, MD4, Koon-Kwan Ng, MD5, Swei Hsueh, MD6, Wuu-Jyh Lin, PhD7, Jenn-Tzong Chen, MSc7 and Tzu-Chen Yen, MD, PhD1

1 Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
2 Biostatistics Consulting Center, Department of Public Health, Chang Gung University, Taoyuan, Taiwan
3 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
4 Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
5 Department of Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
6 Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
7 Institute of Nuclear Energy Research, Taoyuan, Taiwan



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  		FIGURE 1. A 52-y-old woman with cervical cancer stage IVb. (A) 18F-FDG PET scan reveals focal area of slightly increased 18F-FDG-6-phosphate accumulation in right lower PALN (arrow; SUV = 2.49; score 2) in 40-min PET scan. (B) In 3-h scan, lesion is more clearly evident (arrow; SUV = 3.37, RI = 35.34%; score 3).

 


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  		FIGURE 2. A 74-y-old woman had previously treated cervical cancer with unexplained elevated SCC-Ag tumor marker. (A) 18F-FDG PET scan shows increased 18F-FDG-6-phosphate accumulation in left lower PALNs in 40-min scan (arrow; SUV = 6.96; score 4). (B) In 3-h scan, previous lesion is not well demonstrated (arrow).

 


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  		FIGURE 3. Relation of SUVs between 40-min and 3-h scans for 26 TPs in either upper or lower PALNs (subgroup A). {blacksquare}, upper PALN; {circ}, lower PALNs (r = 0.942, P < 0.001). Line plotted is SUV at 3 h = (1.35 + [0.80 x SUV at 40 min]).

 


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  		FIGURE 4. Relation of SUVs between 40 min and 3 h for 12 TPs in both upper and lower PALNs (subgroup B). {blacksquare}, lower PALNs; {circ}, upper PALNs (r = 0.942, P < 0.001). For upper PALNs, solid line plotted is SUV at 3 h = (-0.01 + [1.07 x SUV at 40 min]). For lower PALNs, dashed line plotted is SUV at 3 h = (-0.29 + [1.07 x SUV at 40 min]). There is no significant difference in SUV at 3 h between upper and lower PALNs, after SUV at 40 min was adjusted (P = 0.393).

 




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