TY - JOUR T1 - Prognostic value of retrocrural lymph node involvement revealed by FDG PET/CT in cervical cancer JF - Journal of Nuclear Medicine JO - J Nucl Med SP - 145 LP - 145 VL - 52 IS - supplement 1 AU - Hyung-Jun Im AU - Seok-Ki Kim AU - Tae-Sung Kim AU - Sang-Yoon Park Y1 - 2011/05/01 UR - http://jnm.snmjournals.org/content/52/supplement_1/145.abstract N2 - 145 Objectives After the advent of PET/CT, we often encounter the retrocrural FDG accumulation in the cervical cancer patient due to the spatial information from combined CT. But, the clinical significance of retrocrural LN metastasis has not been fully evaluated in cervical cancer. The aim of this study is to assess prognostic value of retrocrural LN involvement. Methods A total of 222 patients with newly diagnosed FIGO stage IA2~IVA cervical cancer are retrospectively enrolled. All patients were underwent pretreatment FDG PET/CT and treated with curative intent and followed up for a median of 34.2±10.5 mo. Patients were grouped by the most distant level of LN involvement evaluated by FDG PET/CT (none, pelvic, para-aortic, retrocrural, and supra-clavicular LN group). The recurrence free survival rates and hazard ratios were estimated. Results 44.1% of patients had LN involvement according to FDG PET/CT at diagnosis. 22 (9.9%) patients had retrocrural LN involvement. Concomitant supra-clavicular LN involvement in patients with retrocrural LN involvement was 59% (13/22). Only 5 (2.3%) skipped retrocrural LN and metastasized to supra-clavicular LN. All retrocrural LN metastases were accompanied with para-aortic LN metastases. Retrocrural LN group showed significantly worse recurrence free survival than para-aortic LN group (P<0.001) and showed no significant difference with supra-clavicular LN group (P=n.s). The hazard ratios for recurrence free survival were increased according to the most distant level of LN involvement; pelvic 3.61 (95% CI, 1.69 to 7.68), para-aortic 7.24 (2.96 to 17.69), retrocrural 26.27 (10.59 to 65.18), and supra-clavicular 34.01 (15.91 to 72.73). Conclusions Retrocrural LN involvement revealed by FDG PET/CT has significantly worse recurrence outcome than para-aortic LN involvement, rather has similar outcome with supra-clavicular LN metastasis. In cervical cancer, all retrocrural LN involvement are preceded by para-aortic LN and most of them are followed by supra-diaphragmatic LN with some skipped LN metastases ER -