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OtherClinical Investigations (Human)

Lymph node staging with a combined protocol of 18F-FDG PET/MRI and sentinel node SPECT/CT: a prospective study in patients with FIGO I/II cervical carcinoma

Matthias Weissinger, Florin-Andrei Taran, Sergios Gatidis, Stefan Kommoss, Konstantin Nikolaou, Samine Sahbai, Christian la Fougere, Sara Yvonne Brucker and Helmut Dittmann
Journal of Nuclear Medicine January 2021, jnumed.120.255919; DOI: https://doi.org/10.2967/jnumed.120.255919
Matthias Weissinger
1 University Hospital Tuebingen, Department of Nuclear Medicine and Clinical Molecular Imaging, Germany;
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Florin-Andrei Taran
2 University Hospital Zurich, Department of Women's Health, Switzerland;
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Sergios Gatidis
3 University Hospital Tuebingen, Department of Diagnostic and Interventional Radiology, Germany;
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Stefan Kommoss
4 University Hospital Tuebingen, Department of Women's Health, Germany;
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Konstantin Nikolaou
5 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Germany;
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Samine Sahbai
1 University Hospital Tuebingen, Department of Nuclear Medicine and Clinical Molecular Imaging, Germany;
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Christian la Fougere
1 University Hospital Tuebingen, Department of Nuclear Medicine and Clinical Molecular Imaging, Germany;
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Sara Yvonne Brucker
4 University Hospital Tuebingen, Department of Women's Health, Germany;
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Helmut Dittmann
6 University of Tuebingen, Department of Nuclear Medicine and Clinical Molecular Imaging, Germany
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Abstract

Lymph node metastases (LNM) are present in a minority of patients with early stages of cervical carcinomas. As conventional imaging including PET/CT has shown limited sensitivity, systematic lymphadenectomies are often conducted for staging purposes. Therefore, the aim of this prospective study was to analyze the impact of 18F-FDG PET/MRI in addition to sentinel node (SLN) biopsy on lymph node status. Methods: 42 women with initial diagnosis of FIGO IA-IIB cervical carcinomas were included between 03/2016–04/2019. Each patient received preoperative whole body 18F-FDG PET/MRI (Biograph mMR®, Siemens Healthineers) and SLN imaging with SPECT/CT (Discovery 670 Pro®, GE Healthcare) after intracervical injection of 99mTc-labeled nanocolloid. Systematic Lymphadenectomy and SLN biopsy served as reference standard. Staging in PET/MRI was performed as a consensus of nuclear medicine and radiology experts. Results: One patient was excluded from surgical staging due to newly diagnosed liver metastases in PET/MRI. Overall prevalence of LNM in the remaining 41 patients was 29.3% (12/41). 5/12 patients with LNM solely had small metastases with maximum diameter ≤5mm. Interpretation of PET/MRI as a consensus of experts showed a specificity of 100% (29/29, 95%CI: 88.3-100%) for LNM-staging, but a low sensitivity of 33.3% (4/12, 95%CI: 12.8-60.9%). LN size was the most important factor for the detectability of metastases, since only LNM >5mm could be identified by PET/MRI (sensitivity >5mm: 57.1%; ≤5mm: 0%). Paraaortic LNM were evaluated accurately in 3/4 cases (16 patients with paraaortic LN removal). SLNs were detectable by SPECT/CT in 82.9% of the patients or 69.0% of hemipelvis. In cases with undetectable SLN in SPEC/TCT, malignancy rate was considerably higher (31.2% vs. 19.3%). The combination of PET/MRI and SLN SPECT/CT improved the detection of pelvic LNM from 33.3% to 75%. Conclusion: 18F-FDG PET/MRI is a highly specific N-staging method and improves LNM detection. Due to the limited sensitivity in frequently occurring small LNM, PET/MRI should be combined with sentinel node mapping. The proposed combined protocol helps to decide whether extensive surgical staging is necessary in patients with FIGO I/II cervical cancer.

  • Oncology: GYN
  • PET/MRI
  • SPECT/CT
  • 18F-FDG PET/MRI
  • 99mTc-nanocolloid SPECT/CT
  • cervical carcinoma
  • combined protocol
  • sentinel node
  • Copyright © 2021 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

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Journal of Nuclear Medicine: 62 (3)
Journal of Nuclear Medicine
Vol. 62, Issue 3
March 1, 2021
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Lymph node staging with a combined protocol of 18F-FDG PET/MRI and sentinel node SPECT/CT: a prospective study in patients with FIGO I/II cervical carcinoma
Matthias Weissinger, Florin-Andrei Taran, Sergios Gatidis, Stefan Kommoss, Konstantin Nikolaou, Samine Sahbai, Christian la Fougere, Sara Yvonne Brucker, Helmut Dittmann
Journal of Nuclear Medicine Jan 2021, jnumed.120.255919; DOI: 10.2967/jnumed.120.255919

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Lymph node staging with a combined protocol of 18F-FDG PET/MRI and sentinel node SPECT/CT: a prospective study in patients with FIGO I/II cervical carcinoma
Matthias Weissinger, Florin-Andrei Taran, Sergios Gatidis, Stefan Kommoss, Konstantin Nikolaou, Samine Sahbai, Christian la Fougere, Sara Yvonne Brucker, Helmut Dittmann
Journal of Nuclear Medicine Jan 2021, jnumed.120.255919; DOI: 10.2967/jnumed.120.255919
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Keywords

  • Oncology: GYN
  • PET/MRI
  • SPECT/CT
  • 18F-FDG PET/MRI
  • 99mTc-nanocolloid SPECT/CT
  • cervical carcinoma
  • combined protocol
  • sentinel node
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