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Vemula Venkata VL, Hulikal N, Chowhan AK. Effectiveness of sentinel lymph node biopsy and bilateral pelvic nodal dissection using methylene blue dye in early-stage operable cervical cancer-A prospective study. Cancer Treat Res Commun 2024; 39:100816. [PMID: 38714022 DOI: 10.1016/j.ctarc.2024.100816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/16/2024] [Accepted: 04/24/2024] [Indexed: 05/09/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of methylene blue dye in detecting sentinel lymph nodes (SLNs) in women with early-stage operable (defined as FIGO I-IIA) cervical cancer. It also aims to evaluate procedural challenges and accuracy. METHOD This prospective study, which focused on 20 women with early-stage cervical cancer, was carried out between June 2016 and December 2017. These patients had SLN mapping with methylene blue dye injections and thorough examinations, including imaging. All patients underwent radical hysterectomy and complete bilateral pelvic lymphadenectomy. No additional investigation was done on the lymph node in cases where a metastasis was found in the first H&E-stained segment of the sentinel node. RESULT 20 patients were included in the analysis. The median age of the subjects was 53, and 95 % of them had squamous cell carcinoma. 90 % of the time, the identification of SLNs was effective, and 55 SLNs were found, of which 52.7 % were on the right side of the pelvis and 47.3 % on the left. The obturator group had the most nodes, followed by the external and internal iliac groups in descending order of occurrence. Metastasis was detected in 3 patients, resulting in a sensitivity of 100 % and a specificity of 93.75 % for SLN biopsy. Notably, no false-negative SLNs were found. Complications related to methylene blue usage included urine discoloration in 30 % of patients. CONCLUSION This trial highlights the promising efficacy and safety of methylene blue dye alone for SLN identification in early-stage operable cervical cancer, with a notably higher success rate. Despite limitations like a small sample size, healthcare professionals and researchers can build upon the insights from this study to enhance cervical cancer management.
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Affiliation(s)
- Vijaya Lakshmi Vemula Venkata
- Department of Surgical Oncology, St Johns Medical College and Hospital, Johnnagara, Bengaluru, Karnataka, 560034, India.
| | - Narendra Hulikal
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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Liu S, Zhou Y, Wang C, Shen J, Zheng Y. Prediction of lymph node status in patients with early-stage cervical cancer based on radiomic features of magnetic resonance imaging (MRI) images. BMC Med Imaging 2023; 23:101. [PMID: 37528338 PMCID: PMC10392004 DOI: 10.1186/s12880-023-01059-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Lymph node metastasis is an important factor affecting the treatment and prognosis of patients with cervical cancer. However, the comparison of different algorithms and features to predict lymph node metastasis is not well understood. This study aimed to construct a non-invasive model for predicting lymph node metastasis in patients with cervical cancer based on clinical features combined with the radiomic features of magnetic resonance imaging (MRI) images. METHODS A total of 180 cervical cancer patients were divided into the training set (n = 126) and testing set (n = 54). In this cross-sectional study, radiomic features of MRI images and clinical features of patients were collected. The least absolute shrinkage and selection operator (LASSO) regression was used to filter the features. Seven machine learning methods, including eXtreme Gradient Boosting (XGBoost), Logistic Regression, Multinomial Naive Bayes (MNB), Support Vector Machine (SVM), Decision Tree, Random Forest, and Gradient Boosting Decision Tree (GBDT) are used to build the models. Receiver operating characteristics (ROC) curve and area under the curve (AUC), accuracy, sensitivity, and specificity were calculated to assess the performance of the models. RESULTS Of these 180 patients, 49 (27.22%) patients had lymph node metastases. Five of the 122 radiomic features and 3 clinical features were used to build predictive models. Compared with other models, the MNB model was the most robust, with its AUC, specificity, and accuracy on the testing set of 0.745 (95%CI: 0.740-0.750), 0.900 (95%CI: 0.807-0.993), and 0.778 (95%CI: 0.667-0.889), respectively. Furthermore, the AUCs of the MNB models with clinical features only, radiomic features only, and combined features were 0.698 (95%CI: 0.692-0.704), 0.632 (95%CI: 0.627-0.637), and 0.745 (95%CI: 0.740-0.750), respectively. CONCLUSION The MNB model, which combines the radiomic features of MRI images with the clinical features of the patient, can be used as a non-invasive tool for the preoperative assessment of lymph node metastasis.
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Affiliation(s)
- Shuyu Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Bengbu Medical College, No.287 Changhuai Road, Longzihu District, Bengbu, Anhui, 233004, China
| | - Yu Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Bengbu Medical College, No.287 Changhuai Road, Longzihu District, Bengbu, Anhui, 233004, China
| | - Caizhi Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Bengbu Medical College, No.287 Changhuai Road, Longzihu District, Bengbu, Anhui, 233004, China
| | - Junjie Shen
- Department of Radiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 233004, China
| | - Yi Zheng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Bengbu Medical College, No.287 Changhuai Road, Longzihu District, Bengbu, Anhui, 233004, China.
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Zhang Z, Wan X, Lei X, Wu Y, Zhang J, Ai Y, Yu B, Liu X, Jin J, Xie C, Jin X. Intra- and peri-tumoral MRI radiomics features for preoperative lymph node metastasis prediction in early-stage cervical cancer. Insights Imaging 2023; 14:65. [PMID: 37060378 PMCID: PMC10105820 DOI: 10.1186/s13244-023-01405-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/16/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Noninvasive and accurate prediction of lymph node metastasis (LNM) is very important for patients with early-stage cervical cancer (ECC). Our study aimed to investigate the accuracy and sensitivity of radiomics models with features extracted from both intra- and peritumoral regions in magnetic resonance imaging (MRI) with T2 weighted imaging (T2WI) and diffusion weighted imaging (DWI) for predicting LNM. METHODS A total of 247 ECC patients with confirmed lymph node status were enrolled retrospectively and randomly divided into training (n = 172) and testing sets (n = 75). Radiomics features were extracted from both intra- and peritumoral regions with different expansion dimensions (3, 5, and 7 mm) in T2WI and DWI. Radiomics signature and combined radiomics models were constructed with selected features. A nomogram was also constructed by combining radiomics model with clinical factors for predicting LNM. RESULTS The area under curves (AUCs) of radiomics signature with features from tumors in T2WI and DWI were 0.841 vs. 0.791 and 0.820 vs. 0.771 in the training and testing sets, respectively. Combining radiomics features from tumors in the T2WI, DWI and peritumoral 3 mm expansion in T2WI achieved the best performance with an AUC of 0.868 and 0.846 in the training and testing sets, respectively. A nomogram combining age and maximum tumor diameter (MTD) with radiomics signature achieved a C-index of 0.884 in the prediction of LNM for ECC. CONCLUSIONS Radiomics features extracted from both intra- and peritumoral regions in T2WI and DWI are feasible and promising for the preoperative prediction of LNM for patients with ECC.
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Affiliation(s)
- Zhenhua Zhang
- Department of Radiology, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaojie Wan
- Department of Obstetrics and Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiyao Lei
- Department of Radiotherapy Center, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yibo Wu
- Department of Radiotherapy Center, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ji Zhang
- Department of Radiotherapy Center, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yao Ai
- Department of Radiotherapy Center, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bing Yu
- Department of Radiotherapy Center, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xinmiao Liu
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Juebin Jin
- Department of Medical Engineering, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Congying Xie
- Department of Radiation and Medical Oncology, The 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Xiance Jin
- Department of Radiotherapy Center, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
- School of Basic Medical Science, Wenzhou Medical University, Wenzhou, China.
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Chang Y, Li G, Yang Z, Han G, Li X, Zhao Y, Yang Q, Wu G, Yang K, Zhao Y. Inguinal nodal clinical target volume delineation based on analysis of anatomical locations of normal and metastatic lymph nodes in pelvic malignant tumors. Radiother Oncol 2023; 183:109634. [PMID: 36963443 DOI: 10.1016/j.radonc.2023.109634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE To optimize inguinal nodal clinical target volume (CTV) delineation based on analysis of the anatomical locations and embryonic development of normal and metastatic inguinal lymph nodes (ILNs) in patients with pelvic malignant tumors, including cervical, vaginal, vulvar, and anal tumors. MATERIALS AND METHODS One hundred and eighty-one patients with pelvic malignancies and 415 involved ILNs treated with intensity-modulated radiation therapy were selected. First, the inguinal nodal CTV was divided into three fields as follows: I, horizontal superficial inguinal field; II, vertical superficial inguinal field; and III, deep inguinal field. Initial CTV delineation of each field was based on analysis of the anatomical locations and embryonic development of normal ILNs. Subsequently, the positions of metastatic ILNs relative to the proper anatomical landmarks or vessels were determined to optimally delineate the final ILN CTV contours. Eighty percent of the data acquired (n = 145) were used as test data for optimization and analysis, the remaining 20% (n = 36) were used for delineation validation. RESULTS In total, 252 positive ILNs in 103 cervical cancer patients, 94 positive ILNs in 41 vulvar cancer patients, 8 positive ILNs in 3 vaginal cancer patients, and 61 positive ILNs in 34 anal cancer patients were enrolled. Detailed target volume contouring guidelines for the three divisions were determined on images. All positive ILNs from the remaining 20% patients were located in the CTV boundaries delineated based on analysis of 80% of the data acquired. Importantly, the final inguinal nodal CTV field determined using our method was substantially smaller than defined by existing atlases, and the femoral vessels were excluded in the delineation. CONCLUSIONS This study provided anatomical, embryonic, surgical, and statistical evidence to facilitate ILN CTV delineation in radiotherapy planning for patients with pelvic malignancies.
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Affiliation(s)
- Yu Chang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P.R. China
| | - Guilin Li
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P.R. China
| | - Zhiyong Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P.R. China
| | - Guang Han
- Department of Radiation Oncology, Hubei Cancer Hospital, The Seventh Clinical School Affiliated of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430060, China
| | - Xiangpan Li
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Ye Zhao
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P.R. China
| | - Qin Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P.R. China
| | - Gang Wu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P.R. China
| | - Kunyu Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P.R. China.
| | - Yingchao Zhao
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P.R. China.
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Yang S, Zhao J, Zhao H, Hu Y, Zhu H. Development of a nomogram for predicting pelvic lymph node metastasis in cervical squamous cell carcinoma. Int J Gynaecol Obstet 2023; 160:1020-1027. [PMID: 36074057 DOI: 10.1002/ijgo.14441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/25/2022] [Accepted: 08/22/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To develop and validate a nomogram for predicting pelvic lymph node metastasis (LNM) in cervical squamous cell carcinoma (SCC). METHODS This was a retrospective study that included 715 patients with cervical SCC who underwent radical hysterectomy and bilateral pelvic lymphadenectomy between 2009 and 2018. Logistic regression analysis was used to identify independent risk factors for pelvic LNM. Based on these risk factors, a nomogram predicting LNM risk was constructed and internally validated using the bootstrapping resampling method. RESULTS The rate of LNM in FIGO (the International Federation of Gynecology & Obstetrics) Stage IA2-IIA2 cervical SCC was 24.2%. In multivariate analysis, FIGO Stage II, moderately differentiated or poorly differentiated histology, abnormally elevated serum SCC-antigen, and triglyceride were identified as independent risk factors for LNM. Tumor size greater than 2 cm and parametrial involvement had borderline significance. Ultimately, the nomogram contained the six variables mentioned above, showing positive calibration and positive discrimination. The area under the receiver operating characteristic curvewas 0.827 and the bootstrap-validated C-index was 0.827. The Youden index of this paper was 0.540. CONCLUSIONS We developed and validated a nomogram to predict pelvic LNM in SCC based on clinical data, which can help physicians develop an optimal treatment strategy.
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Affiliation(s)
- Simeng Yang
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jing Zhao
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hongqin Zhao
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yan Hu
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haiyan Zhu
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Shanghai, China
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Eshetu HB, Shitu K, Handebo S. Predictors of intention to receive cervical cancer screening among commercial sex workers in Gondar city, northwest Ethiopia: application of the theory of planned behavior. BMC Womens Health 2022; 22:462. [PMID: 36404309 PMCID: PMC9830899 DOI: 10.1186/s12905-022-02055-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cervical cancer is a global public health problem & is the fourth leading cause of cancer morbidity and mortality. Abnormal cervical lesion is common in commercial sex workers and is at a higher risk of developing cervical cancer due to multiple sexual partners besides other factors. Intention is an important predictor of behavior and is an initiative to transform their desire into action. Therefore, this study aimed to assess the predictors of intention to receive cervical cancer screening among commercial sex workers in Gondar city, northwest Ethiopia. METHODS A community-based cross-sectional study was conducted from March 27 to May 25, 2021, in Gondar city, northwest Ethiopia. A total of 425 commercial sex workers selected using convenience sampling techniques were included in the study. Linear regression with robust standard errors was carried out to identify predictors of intention to receive cervical cancer screening. A 95% confidence interval and a p-value of less than 0.05 were used to declare statistical significance. RESULTS A total of 393 commercial sex workers participated in the study with a response rate of 92.4%. The mean age of the participants was 27.68 ± 6.62. The median (interquartile range) of intention was 4 (3-4.25). The theory of planned behaviour variables explained 38.51% of the variance in intention to receive cervical cancer screening. Direct subjective norm (β = 0.09), 95% CI (0.05, 0.13)), direct Attitude (β = 0.09, 95% CI (0.04, 0.13)), past behaviour (β = 0.27; 95% CI (0.09, 0.46), and positive HIV status (β = 0.26; 95% CI (0.06, 0.46) were significant predictors of intention. CONCLUSIONS Commercial sex workers' intention to undergo cervical cancer screening was high. The theory of planned behavior showed adequate utility in predicting commercial sex workers' intention to receive cervical cancer screening. Participant's attitudes, subjective norm, past behavior, and positive HIV status were important factors affecting their intention to receive cervical cancer screening. Thus, interventions aimed at enhancing commercial sex workers' cervical cancer screening behavior should target creating positive social pressure and attitudinal change towards cervical cancer screening.
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Affiliation(s)
- Habitu Birhan Eshetu
- grid.59547.3a0000 0000 8539 4635Department of Health Promotion and Health Behavior, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, PO.Box.196, Gondar, Ethiopia
| | - Kegnie Shitu
- grid.59547.3a0000 0000 8539 4635Department of Health Promotion and Health Behavior, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, PO.Box.196, Gondar, Ethiopia
| | - Simegnew Handebo
- School of Public Health, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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The Oncological Implication of Sentinel Lymph Node in Early Cervical Cancer: A Meta-Analysis of Oncological Outcomes and Type of Recurrences. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111539. [PMID: 36363496 PMCID: PMC9698841 DOI: 10.3390/medicina58111539] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 11/30/2022]
Abstract
Background and Objectives: Pelvic lymphadenectomy has been associated with radical hysterectomy for the treatment of early Cervical Cancer (ECC) since 1905. However, some complications are related to this technique, such as lymphedema and nerve damage. In addition, its clinical role is controversial. For this reason, the sentinel lymph node (SLN) has found increasing use in clinical practice over time. Oncologic safety, however, is debated, and there is no clear evidence in the literature regarding this. Therefore, our meta-analysis aims to schematically analyze the current scientific evidence to investigate the non-inferiority of SLN versus PLND regarding oncologic outcomes. Materials and Methods: Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically searched the PubMed and Scopus databases in June 2022 since their early first publications. We made no restrictions on the country. We considered only studies entirely published in English. We included studies containing Disease-Free Survival (DFS), Overall Survival (OS), Recurrence Rate (RR), and site of recurrence data. We used comparative studies for meta-analysis. We registered this meta-analysis to the PROSPERO site for meta-analysis with protocol number CRD42022316650. Results: Twelve studies fulfilled inclusion criteria. The four comparative studies were enrolled in meta-analysis. Patients were analyzed concerning Sentinel Lymph Node Biopsy (SLN) and compared with Bilateral Pelvic Systematic Lymphadenectomy (PLND) in early-stage Cervical Cancer (ECC). Meta-analysis highlighted no differences in oncological safety between these two techniques, both in DFS and OS. Moreover, most of the sites of recurrences in the SLN group seemed not to be correlated with missed lymphadenectomy. Conclusions: Data in the literature do not seem to show clear oncologic inferiority of SLN over PLND. On the contrary, the higher detection rate of positive lymph nodes and the predominance of no lymph node recurrences give hope that this technique may equal PLND in oncologic terms, improving its morbidity profile.
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Li L, Zhang J, Zhe X, Tang M, Zhang X, Lei X, Zhang L. A meta-analysis of MRI-based radiomic features for predicting lymph node metastasis in patients with cervical cancer. Eur J Radiol 2022; 151:110243. [DOI: 10.1016/j.ejrad.2022.110243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/22/2022] [Accepted: 03/05/2022] [Indexed: 12/23/2022]
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Jia H, Jiang X, Zhang K, Shang J, Zhang Y, Fang X, Gao F, Li N, Dong J. A Nomogram of Combining IVIM-DWI and MRI Radiomics From the Primary Lesion of Rectal Adenocarcinoma to Assess Nonenlarged Lymph Node Metastasis Preoperatively. J Magn Reson Imaging 2022; 56:658-667. [PMID: 35090079 DOI: 10.1002/jmri.28068] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/29/2021] [Accepted: 12/29/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Lymph node (LN) staging plays an important role in treatment decision-making. Current problem is that preoperative detection of LN involvement is always highly challenging for radiologists. PURPOSE To explore the value of the nomogram model combining intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and radiomics features from the primary lesion of rectal adenocarcinoma in assessing the non-enlarged lymph node metastasis (N-LNM) preoperatively. STUDY TYPE Retrospective. POPULATION A total of 126 patients (43% female) comprising a training group (n = 87) and a validation group (n = 39) with pathologically confirmed rectal adenocarcinoma. FIELD STRENGTH/SEQUENCE A 3.0 Tesla (T); T2 -weighted imaging (T2 WI) with fast spin-echo (FSE) sequence; IVIM-DWI spin-echo echo-planar imaging sequence. ASSESSMENT Based on pathological analysis of the surgical specimen, patients were classified into negative LN (LN-) and positive LN (LN+) groups. Apparent diffusion coefficient (ADC), diffusion coefficient (D), pseudo diffusion coefficient (D*) and microvascular volume fraction (f) values of primary lesion of rectal adenocarcinoma were measured. Three-dimensional (3D) radiomics features were measured on T2 WI and IVIM-DWI. A nomogram model including IVIM-DWI and radiomics features was developed. STATISTICAL TESTS General_univariate_analysis and multivariate logistic regression were used for radiomics features selection. The performance of the nomogram was assessed by the receiver operating characteristic (ROC) curve, calibration, and decision curve analysis (DCA). RESULTS The LN+ group had a significantly lower D* value ([13.20 ± 13.66 vs. 23.25 ± 18.71] × 10-3 mm2 /sec) and a higher f value (0.43 ± 0.12 vs. 0.34 ± 0.10) than the LN- group in the training cohort. The nomogram model combined D*, f, and radiomics features had a better evaluated performance (AUC = 0.864) than any other model in the training cohort. DATE CONCLUSION The nomogram model including IVIM-DWI and MRI radiomics features in the primary lesion of rectal adenocarcinoma was associated with the N-LNM. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Haodong Jia
- Department of Radiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, 230001, China
| | - Xueyan Jiang
- Graduate school, Bengbu Medical College, Anhui Province, 233030, China
| | - Kaiyue Zhang
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, 230001, China
| | - Jin Shang
- Department of Radiology, The First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Cancer Hospital, Hefei, 230031, China
| | - Yu Zhang
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, 230001, China
| | - Xin Fang
- Department of Radiology, The First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Cancer Hospital, Hefei, 230031, China
| | - Fei Gao
- Department of Radiology, The First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Cancer Hospital, Hefei, 230031, China
| | - Naiyu Li
- Department of Radiology, The First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Cancer Hospital, Hefei, 230031, China
| | - Jiangning Dong
- Department of Radiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, 230001, China.,Department of Radiology, The First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Cancer Hospital, Hefei, 230031, China
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Lee YH, Chong GO, Kim SJ, Hwang JH, Kim JM, Park NJY, Hong DG. Prognostic Value of Lymph Node Characteristics in Patients with Cervical Cancer Treated with Radical Hysterectomy. Cancer Manag Res 2021; 13:8137-8145. [PMID: 34737642 PMCID: PMC8560076 DOI: 10.2147/cmar.s332612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/17/2021] [Indexed: 01/09/2023] Open
Abstract
Objective This study evaluated the prognostic value of various lymph node (LN) characteristics, including the lymph node ratio (LNR), in patients with cervical cancer treated with radical hysterectomy. Methods In this retrospective study, 260 patients with cervical cancer who had undergone radical hysterectomy with pelvic or paraaortic lymphadenectomies were included. LN characteristics related to several LN statuses included total LN counts, LN metastasis, total positive LN counts, LNR, and levels of lymphadenectomy. LNR was defined as the number of metastatic LNs divided by the total number of LNs harvested. Univariate and multivariate analyses for disease-free survival (DFS) and overall survival (OS) were performed using the clinicopathological and LN characteristics. Results Based on receiver-operating characteristics curve analysis, the cut-off value of LNR was 0.0625. Multivariate analysis revealed that high LNR was significantly related to tumor recurrence (hazard ratio [HR], 5.182; 95% confidence interval [CI], 2.424–11.075; p < 0.0001). After adjusting for clinicopathological factors, LNR was also independent prognostic factor for predicting tumor recurrence (HR, 5.930; 95% CI, 2.114–16.634; p = 0.0007). However, total retrieved LN counts and level of lymphadenectomy were not associated with survival outcomes. Conclusion LNR may be a prognostic biomarker for predicting disease recurrence in cervical cancer treated with radical hysterectomy.
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Affiliation(s)
- Yoon Hee Lee
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea.,Clinical Omics Research Center, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Gun Oh Chong
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea.,Clinical Omics Research Center, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Su Jeong Kim
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Ja Hyun Hwang
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Jong Mi Kim
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Nora Jee-Young Park
- Clinical Omics Research Center, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Dae Gy Hong
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
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11
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The relationship between lymphedema severity and awareness of lymphedema surgery. Arch Plast Surg 2021; 48:534-542. [PMID: 34583441 PMCID: PMC8490117 DOI: 10.5999/aps.2020.02215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 05/27/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND During the early stages of lymphedema, active physiologic surgical treatment can be applied. However, lymphedema patients often have limited knowledge and misconceptions regarding lymphedema and surgical treatment. We analyzed the correlations between lymphedema severity and surgical technique according to patients' awareness of surgical treatment for secondary upper extremity lymphedema (UEL). METHODS Patients with UEL diagnosed between December 2017 and December 2019 were retrospectively evaluated. At the time of their presentation to our hospital for the treatment of lymphedema, they were administered a questionnaire about lymphedema and lymphedema surgery. Based on the results, patients were classified as being aware or unaware of surgical treatment. Lymphedema severity was classified according to the arm dermal backflow (ADB) stage and the MD Anderson Cancer Center (MDACC) stage based on indocyanine green lymphography conducted at presentation. Surgical techniques were compared between the two groups. RESULTS Patients who were aware of surgical treatment had significantly lower initial ADB and MDACC stages (P<0.05) and more frequently underwent physiologic procedures than excisional procedures (P=0.003). CONCLUSIONS If patients are actively educated regarding surgical treatment of lymphedema, physiologic procedures may be performed during the early stages of UEL.
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12
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Wang L, Liu S, Xu T, Yuan L, Yang X. Sentinel lymph node mapping in early-stage cervical cancer: Meta-analysis. Medicine (Baltimore) 2021; 100:e27035. [PMID: 34449483 PMCID: PMC8389869 DOI: 10.1097/md.0000000000027035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 08/09/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The value of sentinel lymph node (SLN) mapping for early-stage cervical cancer remains controversial. Therefore, we collected data to investigate the feasibility and diagnostic accuracy of SLN in patients with early-stage (IA-IIA) cervical cancer. METHODS We searched Embase, PubMed, and the Cochrane Library databases issued before June 1, 2020. The sample size of the selected study was at least 10 patients with early-stage (IA-IIA) cervical cancer, the pooled detection rates and the separate detection rate (overall detection rate, bilateral detection rate) using blue dye with Tc, technetium 99 (Tc) and indocyanine green (ICG) technique of early-stage cervical cancer was reported. R-3.6.1 software was used to evaluate pooled detection rate and sensitivity. RESULTS Two thousand one hundred sixty-four patients included for analysis in 28 studies ranging from 12 to 405 patients. The combined overall detection rate of SLN mapping was 95% with a 72% pooled bilateral detection rate. The sensitivity of the combined overall detection rate of SLN mapping was 94.99% as well as a sensitivity of 72.43% bilateral detection rate. The overall detection rate of SLN was 96% for blue dye with Tc, 95% for Tc, 98% for ICG technique. The bilateral detection rate of SLN was 76% for blue dye with Tc, 63% for Tc, 85% for ICG technique. The sensitivity of the overall detection rate of SLN mapping was 97.76% as well as a sensitivity of 84.96% bilateral detection rate of ICG technique. CONCLUSION In early-stage cervical cancer, overall detection rate of SLN mapping is elevated while bilateral detection rate is lower. The overall detection rate (98%) as well as bilateral rate (85%) of ICG seems to be a better SLN mapping technique among the method of SLN mapping (using blue dye with Tc, Tc or ICG). We believe SLN mapping may be considered contemporary technique which could provide additional benefits over traditional pelvic lymphadenectomy. While promising results in SLN mapping has been found, larger patient samples, including randomized studies, are required at the same time.
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Affiliation(s)
- Lijun Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Shanshan Liu
- Department of Clinical Laboratory, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Ting Xu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Linnan Yuan
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Xinyuan Yang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
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13
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Manganaro L, Nicolino GM, Dolciami M, Martorana F, Stathis A, Colombo I, Rizzo S. Radiomics in cervical and endometrial cancer. Br J Radiol 2021; 94:20201314. [PMID: 34233456 PMCID: PMC9327743 DOI: 10.1259/bjr.20201314] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Radiomics is an emerging field of research that aims to find associations between quantitative information extracted from imaging examinations and clinical data to support the best clinical decision. In the last few years, some papers have been evaluating the role of radiomics in gynecological malignancies, mainly focusing on ovarian cancer. Nonetheless, cervical cancer is the most frequent gynecological malignancy in developing countries and endometrial cancer is the most common in western countries. The purpose of this narrative review is to give an overview of the latest published papers evaluating the role of radiomics in cervical and endometrial cancer, mostly evaluating association with tumor prognostic factors, with response to therapy and with prediction of recurrence and distant metastasis.
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Affiliation(s)
- Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences; University of Rome Sapienza (IT), Rome, Italy
| | - Gabriele Maria Nicolino
- Post-graduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, Milan, Italy
| | - Miriam Dolciami
- Department of Radiological, Oncological and Pathological Sciences; University of Rome Sapienza (IT), Rome, Italy
| | - Federica Martorana
- Oncology Institute of Southern Switzerland, San Giovanni Hospital, 6500 Bellinzona, (CH), Switzerland
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, San Giovanni Hospital, 6500 Bellinzona, (CH), Switzerland.,Facoltà di Scienze biomediche, Università della Svizzera italiana (USI), Via Buffi 13, 6900, Lugano (CH), Switzerland
| | - Ilaria Colombo
- Oncology Institute of Southern Switzerland, San Giovanni Hospital, 6500 Bellinzona, (CH), Switzerland
| | - Stefania Rizzo
- Facoltà di Scienze biomediche, Università della Svizzera italiana (USI), Via Buffi 13, 6900, Lugano (CH), Switzerland.,Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale, Via Tesserete 46, Lugano (CH), Switzerland
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14
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Kim WJ, Kim J, Kang M, Park DH, Jeon JY. Usefulness of computed tomography venography in gynecologic cancer patients with lower extremity edema. Medicine (Baltimore) 2020; 99:e21818. [PMID: 32925718 PMCID: PMC7489682 DOI: 10.1097/md.0000000000021818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Lower extremity (LEx) edema is a common complication in gynecologic cancer patients. There are 2 main causes of edema in these patients such as deep vein thrombosis (DVT) and lymphedema. Early diagnosis and treatment of DVT are certainly important, but it is often difficult to evaluate proximal DVT by using ultrasound. The aim of this study is to demonstrate the usefulness of computed tomography venography of the lower extremity (CTV LEx) for the diagnosis of the DVT and investigate predictive factor of DVT in gynecologic cancer patients with LEx edema.The medical records of 415 gynecologic cancer patients who were referred to the department of rehabilitation medicine with LEx edema were retrospectively reviewed in this case-controlled study. We categorized CTV LEx findings as follows: DVT proximal to the inguinal ligament (inferior vena cava or iliac vein thrombosis) and DVT distal to the inguinal ligament (femoral, popliteal, or calf vein thrombosis). We also evaluated patient characteristics including D-dimer level. We analyzed the correlation of each factor with DVT frequency and used receiver operating characteristic curve analysis to determine the appropriate D-dimer threshold.Sixty-six patients were diagnosed with DVT; of them, 35 (53%) had DVT proximal to the inguinal ligament. Twenty-two patients were diagnosed with pulmonary embolism, of whom 15 had proximal DVT. Patients with proximal DVT tended to have pulmonary embolism (P < .001). Distal organ metastasis (odds ratio [OR], 2.88; P = .002) and a high D-dimer level (OR, 1.13; P = .001) were correlated with DVT.CTV LEx is a useful diagnostic tool for gynecologic cancer patients with LEx edema, particularly high-risk patients, that should be performed at the initial evaluation.
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15
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Radiomics in cervical cancer: Current applications and future potential. Crit Rev Oncol Hematol 2020; 152:102985. [DOI: 10.1016/j.critrevonc.2020.102985] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/13/2022] Open
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16
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Reyneke F, Snyman LC, Lawal I, Lengana T, Vorster M, Sathekge M. Diagnostic value of sentinel lymph node scintigraphy and 2-[ 18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography in the detection of metastatic lymph nodes in patients with early-stage cervical cancer. World J Nucl Med 2020; 19:240-245. [PMID: 33354179 PMCID: PMC7745871 DOI: 10.4103/wjnm.wjnm_74_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/07/2019] [Indexed: 11/04/2022] Open
Abstract
Cervical cancer is staged clinically using the International Federation of Gynaecology and Obstetrics staging system. Although lymph node status does not form part of the staging, it has important prognostic and potential therapeutic implications. The aim of the study was to evaluate the role of sentinel lymph node (SLN) scintigraphy and 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) in detecting lymph node metastases in patients with early-stage cervical cancer. Thirty-six patients with early-stage cervical cancer underwent SLN detection during primary operation. Of the 36 patients, 28 patients underwent 18F-FDG PET/CT before surgery. The 18F-FDG PET/CT images were analyzed with the histopathological findings as the reference standard. The diagnostic performance of 18F-FDG PET/CT in the detection of nodal disease was reported in terms of accuracy value. The SLN detection rate was the highest (91.7%) using the combined method (lymphoscintigraphy, intraoperative gamma probe, and blue dye). Seven of the thirty-six patients had lymph node involvement (19.4%), of which five had preoperative 18F-FDG PET/CT imaging. On overall patient-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of 18F-FDG PET/CT were 40.0%, 78.3%, 28.6%, 85.7%, and 71.4%, respectively. The combination of radiolabeled nanocolloid with blue dye is safe and reliable and allows successful detection of SLNs in patients with early-stage cervical cancer in a population with high prevalence of human immunodeficiency virus. The specificity and NPV of 18F-FDG PET/CT are high and can be used in conjunction with SLN biopsy.
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Affiliation(s)
- Florette Reyneke
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Leon Cornelius Snyman
- Department of Obstetrics and Gynaecology, University of Pretoria and Kalafong Hospital, Pretoria, South Africa
| | - Ismaheel Lawal
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Thabo Lengana
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Mariza Vorster
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Mike Sathekge
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
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17
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Wang Y, Dan Z, Yuan G, Zhang G, Liu S, Zhang Y, Li B. Detection of sentinel lymph node in laparoscopic surgery for uterine cervical cancer using carbon nanoparticles. J Surg Oncol 2020; 122:934-940. [PMID: 32614998 DOI: 10.1002/jso.26100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/22/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Carbon nanoparticles (CNPs) has been widely confirmed the efficiency in sentinel lymph node (SLN) mapping for various solid tumors. This study aims to explore the feasibility and effectiveness of CNPs during laparoscopic surgery for cervical cancer. METHODS We analyzed 45 women with stage IB1-IIA1 cervical cancer who underwent SLN mapping using CNPs during laparoscopic surgery. The effectiveness of CNPs was evaluated by the detection rate and accuracy parameters. Factors associated with SLN laterality and SLNs localizations were analyzed. RESULTS The overall and bilateral detection rate was 93.3% (42/45) and 60.0% (27/45), respectively. Elevated body mass index was associated with decreased bilateral detection rate (P = .015). A total of 225 SLNs were harvested, with a mean number of 5.0 ± 3.6. A total of 81.3% of SLNs were in expected localizations including external iliac (39.1%), internal iliac (25.8%), and obturator (16.4%) regions, while 18.7% in unusual localizations including common iliac (10.7%), parametrial (7.6%), and presarcal (0.4%) regions. None positive lymph node was found in non-SLNs with a false-negative rate of 0%. CONCLUSION Laparoscopic SLN mapping with CNPs appears to be simple and efficient for patients with early-stage cervical cancer.
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Affiliation(s)
- Yating Wang
- Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhao Dan
- Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guangwen Yuan
- Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gongyi Zhang
- Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuanghuan Liu
- Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanan Zhang
- Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Li
- Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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18
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Wu Q, Wang S, Zhang S, Wang M, Ding Y, Fang J, Wu Q, Qian W, Liu Z, Sun K, Jin Y, Ma H, Tian J. Development of a Deep Learning Model to Identify Lymph Node Metastasis on Magnetic Resonance Imaging in Patients With Cervical Cancer. JAMA Netw Open 2020; 3:e2011625. [PMID: 32706384 PMCID: PMC7382006 DOI: 10.1001/jamanetworkopen.2020.11625] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE Accurate identification of lymph node metastasis preoperatively and noninvasively in patients with cervical cancer can avoid unnecessary surgical intervention and benefit treatment planning. OBJECTIVE To develop a deep learning model using preoperative magnetic resonance imaging for prediction of lymph node metastasis in cervical cancer. DESIGN, SETTING, AND PARTICIPANTS This diagnostic study developed an end-to-end deep learning model to identify lymph node metastasis in cervical cancer using magnetic resonance imaging (MRI). A total of 894 patients with stage IB to IIB cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy were reviewed. All patients underwent radical hysterectomy and pelvic lymphadenectomy, received pelvic MRI within 2 weeks before the operations, had no concurrent cancers, and received no preoperative treatment. To achieve the optimal model, the diagnostic value of 3 MRI sequences was compared, and the outcomes in the intratumoral and peritumoral regions were explored. To mine tumor information from both image and clinicopathologic levels, a hybrid model was built and its prognostic value was assessed by Kaplan-Meier analysis. The deep learning model and hybrid model were developed on a primary cohort consisting of 338 patients (218 patients from Sun Yat-sen University Cancer Center, Guangzhou, China, between January 2011 and December 2017 and 120 patients from Henan Provincial People's Hospital, Zhengzhou, China, between December 2016 and June 2018). The models then were evaluated on an independent validation cohort consisting of 141 patients from Yunnan Cancer Hospital, Kunming, China, between January 2011 and December 2017. MAIN OUTCOMES AND MEASURES The primary diagnostic outcome was lymph node metastasis status, with the pathologic characteristics diagnosed by lymphadenectomy. The secondary primary clinical outcome was survival. The primary diagnostic outcome was assessed by receiver operating characteristic (area under the curve [AUC]) analysis; the primary clinical outcome was assessed by Kaplan-Meier survival analysis. RESULTS A total of 479 patients (mean [SD] age, 49.1 [9.7] years) fulfilled the eligibility criteria and were enrolled in the primary (n = 338) and validation (n = 141) cohorts. A total of 71 patients (21.0%) in the primary cohort and 32 patients (22.7%) in the validation cohort had lymph node metastais confirmed by lymphadenectomy. Among the 3 image sequences, the deep learning model that used both intratumoral and peritumoral regions on contrast-enhanced T1-weighted imaging showed the best performance (AUC, 0.844; 95% CI, 0.780-0.907). These results were further improved in a hybrid model that combined tumor image information mined by deep learning model and MRI-reported lymph node status (AUC, 0.933; 95% CI, 0.887-0.979). Moreover, the hybrid model was significantly associated with disease-free survival from cervical cancer (hazard ratio, 4.59; 95% CI, 2.04-10.31; P < .001). CONCLUSIONS AND RELEVANCE The findings of this study suggest that deep learning can be used as a preoperative noninvasive tool to diagnose lymph node metastasis in cervical cancer.
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Affiliation(s)
- Qingxia Wu
- College of Medicine and Biomedical Information Engineering, Northeastern University, Shenyang, Liaoning, China
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Shuo Wang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- Beijing Advanced Innovation Center for Big Data–Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, China
| | - Shuixing Zhang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Meiyun Wang
- Department of Medical Imaging, Henan Provincial People's Hospital, Zhengzhou, Henan, China
- People's Hospital of Zhengzhou University, Zhengzhou, Henan, China
- People's Hospital of Henan University, Zhengzhou, Henan, China
| | - Yingying Ding
- Department of Radiology, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, Yunnan, China
| | - Jin Fang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Qingxia Wu
- Department of Medical Imaging, Henan Provincial People's Hospital, Zhengzhou, Henan, China
- People's Hospital of Zhengzhou University, Zhengzhou, Henan, China
- People's Hospital of Henan University, Zhengzhou, Henan, China
| | - Wei Qian
- Department of Electrical and Computer Engineering, University of Texas at El Paso
| | - Zhenyu Liu
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Kai Sun
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi, China
| | - Yan Jin
- Department of Radiology, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, Yunnan, China
| | - He Ma
- College of Medicine and Biomedical Information Engineering, Northeastern University, Shenyang, Liaoning, China
| | - Jie Tian
- College of Medicine and Biomedical Information Engineering, Northeastern University, Shenyang, Liaoning, China
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- Beijing Advanced Innovation Center for Big Data–Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
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19
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Gianoni M, Mathevet P, Uzan C, Bats AS, Magaud L, Boutitie F, Lécuru F. Does the Sentinel Lymph Node Sampling Alone Improve Quality of Life in Early Cervical Cancer Management? Front Surg 2020; 7:31. [PMID: 32596252 PMCID: PMC7303263 DOI: 10.3389/fsurg.2020.00031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/11/2020] [Indexed: 12/20/2022] Open
Abstract
Objective: In this subanalysis of the prospective randomized multicenter SENTICOL 2 study, we compared the quality of life (QoL), in two arms, in association with lower-limb consequences in women with early stage cervical cancer undergoing randomized sentinel lymph node (SLN) sampling alone or SLN sampling and full pelvic lymphadenectomy. Methods: 206 patients with an early stage cervical cancer and a negative SLN, were randomized. Every patient had a SLN detection based on a combination of radio-isotope (Nanocis®) and blue dye (Bleu Patenté®) injections. One hundred and One patients, the "standard" group, had complete pelvic lymphadenectomy, 105 patients, the "SLN alone" group, had SLN biopsy without lymphadenectomy. At each visit (V0: preoperative, V1: 1 month, V2: 3 months and V3: 6 months following surgery) the patients completed a Short Form Health Survey (SF36) questionnaire and another questionnaire related to leg lymphedema. SF36 scores variations (compared to the baseline values) were assessed with a standard analysis and by an evaluation of the area under the curve (AUC). Several lower-limb circumferences and signs were also determined. Results: General characteristics of the patients were well-balanced between groups. Physical function and general health dimensions of the SF36 scale were significantly improved at V1 and V2 in the "SLN alone" group. Mental health was also statistically better in the "SLN alone" group at V2. Other dimensions were similar. The two groups had similar evaluation at V3. AUC of SF36 sub-scores was also in favor of the "SLN alone" arm, but the difference was not statistically significant. The analysis about the lymphedema of the legs showed a reduced (but not significant) risk in the "SLN alone" group for the top-of-thigh and the mid-thigh perimeters. Lymphedema symptoms reported by the patients were significantly less severe in the "SLN alone" group. Conclusion: Our study demonstrates a trend for a better quality of life and less severe leg heaviness and leg fatigue when a full pelvic lymphadenectomy is avoided.
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Affiliation(s)
| | - Patrice Mathevet
- UNIL et Service de Gynécologie, CHUV, Lausanne, Switzerland
- Univ Lyon, Université Claude Bernard Lyon 1, Villejuif, France
| | - Catherine Uzan
- Service de chirurgie gynécologique, Institut Gustave Roussy, Villejuif, France
- Service de Chirurgie et Cancérologie Gynécologique et Mammaire, 83Bvd de L'hôpital, Paris, France
| | - Anne Sophie Bats
- Service de Chirurgie Gynécologique, Hôpital Européen Georges Pompidou, Paris, France
| | - Laurent Magaud
- Hospices Civils de Lyon, Pôle Santé Publique, Service Recherche et épidémiologie Cliniques, Lyon, France
| | - Florent Boutitie
- Service de Biostatistiques, Batiment 4D, CHLS, Ch. Du Grand Revoyet, Pierre-Bénite, France
| | - Fabrice Lécuru
- Service de chirurgie et cancérologie gynécologique et mammaire, Institut Curie, Paris, France
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20
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Jin X, Ai Y, Zhang J, Zhu H, Jin J, Teng Y, Chen B, Xie C. Noninvasive prediction of lymph node status for patients with early-stage cervical cancer based on radiomics features from ultrasound images. Eur Radiol 2020; 30:4117-4124. [PMID: 32078013 DOI: 10.1007/s00330-020-06692-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/18/2019] [Accepted: 01/30/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate the feasibility of a noninvasive detection of lymph node metastasis (LNM) for early-stage cervical cancer (ECC) patients with radiomics methods based on the textural features from ultrasound images. METHODS One hundred seventy-two ECC patients between January 2014 and September 2018 with pathologically confirmed lymph node status (LNS) and preoperative ultrasound images were retrospectively reviewed. Regions of interest (ROIs) were delineated by a senior radiologist in the ultrasound images. LIFEx was applied to extract textural features for radiomics study. Least absolute shrinkage and selection operator (LASSO) regression was applied for dimension reduction and for selection of key features. A multivariable logistic regression analysis was adopted to build the radiomics signature. The Mann-Whitney U test was applied to investigate the correlation between radiomics and LNS for both training and validation cohorts. Receiver operating characteristic (ROC) curves were applied to evaluate the accuracy of the radiomics prediction models. RESULTS A total of 152 radiomics features were extracted from ultrasound images, in which 6 features were significantly associated with LNS (p < 0.05). The radiomics signatures demonstrated a good discrimination between patients with LNM and non-LNM groups. The best radiomics performance model achieved an area under the curve (AUC) of 0.79 (95% confidence interval (CI), 0.71-0.88) in the training cohort and 0.77 (95% CI, 0.65-0.88) in the validation cohort. CONCLUSIONS The feasibility of radiomics features from ultrasound images for the prediction of LNM in ECC was investigated. This noninvasive prediction method may be used to facilitate preoperative identification of LNS in patients with ECC. KEY POINTS • Few studied had investigated the feasibility of radiomics based on ultrasound images for cervical cancer, even though it is the most common practice for gynecological cancer diagnosis and treatment. • The radiomics signatures based on ultrasound images demonstrated a good discrimination between patients with and without lymph node metastasis with an area under the curve (AUC) of 0.79 and 0.77 in the training and validation cohorts, respectively. • The radiomics model based on preoperative ultrasound images has the potential ability to predict lymph node status noninvasively in patients with early-state cervical cancer, so as to reduce the impact of invasive examination and to optimize the treatment choices.
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Affiliation(s)
- Xiance Jin
- Department of Radiation and Medical Oncology, The 1st Affiliated Hospital of Wenzhou Medical University, Shangcai Village, Wenzhou, 325000, People's Republic of China
| | - Yao Ai
- Department of Radiation and Medical Oncology, The 1st Affiliated Hospital of Wenzhou Medical University, Shangcai Village, Wenzhou, 325000, People's Republic of China
| | - Ji Zhang
- Department of Radiation and Medical Oncology, The 1st Affiliated Hospital of Wenzhou Medical University, Shangcai Village, Wenzhou, 325000, People's Republic of China
| | - Haiyan Zhu
- Department of Gynecology, The 1st Affiliated Hospital of Wenzhou Medical University, Shangcai Village, Wenzhou, 325000, People's Republic of China
- Department of Gynecology, Shanghai First Maternal and Infant Hospital, Tongji University School of Medicine, Shanghai, 200126, People's Republic of China
| | - Juebin Jin
- Department of Medical Engineering, The 1st Affiliated Hospital of Wenzhou Medical University, Shangcai Village, Wenzhou, 325000, People's Republic of China
| | - Yinyan Teng
- Department of Ultrasound imaging, The 1st Affiliated Hospital of Wenzhou Medical University, Shangcai Village, Wenzhou, 325000, People's Republic of China
| | - Bin Chen
- Department of Ultrasound imaging, The 1st Affiliated Hospital of Wenzhou Medical University, Shangcai Village, Wenzhou, 325000, People's Republic of China.
| | - Congying Xie
- Department of Radiation and Medical Oncology, The 1st Affiliated Hospital of Wenzhou Medical University, Shangcai Village, Wenzhou, 325000, People's Republic of China.
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Xu C, Du S, Zhang S, Wang B, Dong C, Sun H. Value of integrated PET-IVIM MR in assessing metastases in hypermetabolic pelvic lymph nodes in cervical cancer: a multi-parameter study. Eur Radiol 2020; 30:2483-2492. [PMID: 32040728 DOI: 10.1007/s00330-019-06611-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/13/2019] [Accepted: 12/06/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the value of integrated multi-parameter positron emission tomography-intravoxel incoherent motion magnetic resonance (PET-IVIM MR) imaging for pelvic lymph nodes with high FDG uptake in cervical cancer, and to determine the best combination of parameters. METHODS A total of 38 patients with 59 lymph nodes with high FDG uptake were included. The imaging parameters of the lymph nodes were calculated by PET-IVIM MR, and the differences between lymph nodes diagnosed by postoperative pathology as metastasis versus non-metastasis were compared. We used the receiver operating characteristic (ROC) curve and logistic regression to construct a combination prediction model to filter low value and similar parameters, in order to search the optimal combination of PET/MR parameters for predicting pathologically confirmed metastatic lymph nodes. The correlation between diffusion parameters and metabolic parameters was analyzed by Spearman's rank correlation. RESULTS The maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), total metabolic tumor volume (MTV), total lesion glycolysis (TLG), apparent diffusion coefficient (ADC), diffusion-related coefficient (D), and perfusion-related parameter (F) showed significant differences between the metastatic and non-metastatic groups (p < 0.05). The combination of MTV, SUVmax, and D had the strongest predictive value (area under the ROC 0.983, p < 0.05). SUVmax, SUVmean, and TLG weakly correlated with F (R = - 0.306, - 0.290, and - 0.310; p < 0.05). CONCLUSIONS The combination of MTV, SUVmax, and D may have a better diagnostic performance than PET- or IVIM-derived parameters either in combination or individually. No strong correlation exists between diffusion parameters and metabolic parameters. KEY POINTS • Integrated PET-IVIM MR may assist to characterize lymph node status. • The combination of MTV, SUVmax, and D may have a better diagnostic performance than PET- or IVIM-derived parameters either in combination or individually for the assessment of pelvic lymph nodes with high FDG uptake. • No strong correlation exists between diffusion parameters and metabolic parameters in pelvic lymph nodes with high FDG uptake.
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Affiliation(s)
- Chen Xu
- Department of Radiology, Shengjing Hospital of China Medical University, Sanhao Street No 36, Heping District, Shenyang, 110004, Liaoning, China.,Liaoning Provincial Key Laboratory of Medical Imaging, Sanhao Street No 36, Heping District, Shenyang, 110004, Liaoning, China
| | - Siyao Du
- Department of Radiology, Shengjing Hospital of China Medical University, Sanhao Street No 36, Heping District, Shenyang, 110004, Liaoning, China
| | - Siyu Zhang
- Department of Radiology, Shengjing Hospital of China Medical University, Sanhao Street No 36, Heping District, Shenyang, 110004, Liaoning, China
| | - Bo Wang
- Department of Radiology, Shengjing Hospital of China Medical University, Sanhao Street No 36, Heping District, Shenyang, 110004, Liaoning, China
| | | | - Hongzan Sun
- Department of Radiology, Shengjing Hospital of China Medical University, Sanhao Street No 36, Heping District, Shenyang, 110004, Liaoning, China.
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Li K, Sun H, Guo Q. Combinative evaluation of primary tumor and lymph nodes in predicting pelvic lymphatic metastasis in early-stage cervical cancer: A multiparametric PET-CT study. Eur J Radiol 2019; 113:153-157. [PMID: 30927941 DOI: 10.1016/j.ejrad.2019.02.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 09/17/2018] [Accepted: 02/12/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE The purpose of this study is to investigate the value of combining tumor and pelvic lymph node (PLN) characteristics on PET-CT in predicting PLN metastasis of patients with early-stage cervical cancer, specifically to further reduce the false-negative cases of diagnosis. METHODS The [18F] FDG PET-CT imaging data of 394 patients who were newly diagnosed with cervical cancer (FIGO stage, Ia-IIa) were retrospectively studied. We measured size, total lesion glycolysis (TLG) of tumor, metabolic tumor volume (MTV), maximum and mean standardized uptake value (SUVmax, SUVmean) of tumor and lymph node (LN). Diagnostic efficiency was evaluated using receiver operator characteristic (ROC) curve. We also investigated additional CT diagnosis information in PET-negative cases. RESULTS Our results indicated both lymph node and tumor parameters were independent risk factors for lymphatic metastasis in early-stage cervical cancer. The diagnosis based on above meaningful parameters, we name it 'combination diagnosis', offered significantly higher predictive value than that based on SUV measurement alone, which the values of AUC were 0.842 and 0.784 respectively (P < 0.05). In PET-negative cases, we also found that tumor TLG, suspicious LN in lymphatic drainage pathway, long/short axis of LN ≤ 2, heterogeneity of LN significantly associated with PLN metastasis. ROC analysis showed combination diagnosis of all these parameters above produced an AUC value of 0.859 (P < 0.05, 95% CI, 0.811-0.899), which was significantly higher than either using tumor TLG alone (AUC = 0.622, Z = 3.919, P < 0.05) or indices derived from CT alone (AUC = 0.727, 0.668, 0.695. Z = 3.620, 5.356, 3.696, P < 0.05). CONCLUSIONS We proposed a combination diagnosis method that can better predict PLN metastasis for patients with early-stage cervical cancer. In PET-negative cases, combination diagnosis of TLG of tumor and CT indicators also produced improved prediction by reducing false-negative cases of diagnosis. This combination diagnosis approach has significant implications in cervical cancer patient management and treatment planning.
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Affiliation(s)
- Kexin Li
- Department of Radiology, Shengjing Hospital of China Medical University, Sanhao Street No36, Heping District, Shenyang, Liaoning, 110004, PR China
| | - Hongzan Sun
- Department of Radiology, Shengjing Hospital of China Medical University, Sanhao Street No36, Heping District, Shenyang, Liaoning, 110004, PR China.
| | - Qiyong Guo
- Department of Radiology, Shengjing Hospital of China Medical University, Sanhao Street No36, Heping District, Shenyang, Liaoning, 110004, PR China
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Cheng-Yen Lai J, Lai KJ, Yi-Yung Yu E, Hung ST, Chu CY, Wang KL. Sentinel lymphatic mapping among women with early-stage cervical cancer: A systematic review. Taiwan J Obstet Gynecol 2019; 57:636-643. [PMID: 30342642 DOI: 10.1016/j.tjog.2018.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2018] [Indexed: 11/26/2022] Open
Abstract
The presence of pelvic lymph node metastases is without doubt the most significant prognostic factor that determines recurrences and survival of women with early-stage cervical cancer. To avoid the underdiagnosis of lymph node metastasis, pelvic lymphadenectomy procedure is routinely performed with radical hysterectomy procedure. However, the pelvic lymphadenectomy procedure may not be necessary in most of these women due to the relatively low incidence of pelvic lymph node metastasis. The removal of large numbers of pelvic lymph nodes could also render non-metastatic irreversible damages for these women, including vessel, nerve, or ureteral injuries; formation of lymphocysts; and lymphedema. Over the past decades, the concept of sentinel lymph node biopsy has emerged as a popular and widespread surgical technique for the evaluation of the pelvic lymph node status in gynecologic malignancies. The histological status of sentinel lymph node should be representative for all other lymph nodes in the regional drainage area. If metastasis is non-existent in the sentinel lymph node, the likelihood of metastatic spread in the remaining regional lymph nodes is very low. Further lymphadenectomy is therefore not necessary for a patient with negative sentinel lymph nodes. Since the uterine cervix has several lymphatic drainage pathways, it is a challenging task to assess the distribution pattern of sentinel lymph nodes in women with early-stage cervical cancer. This review article will adapt the methodology proposed in these studies to systematically review sentinel lymphatic mapping among women with early-stage cervical cancer.
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Affiliation(s)
- Jerry Cheng-Yen Lai
- Department of Medical Research, Taitung MacKay Memorial Hospital, Taitung, Taiwan
| | - Kuan-Ju Lai
- Department of Pathology, Taitung MacKay Memorial Hospital, Taitung, Taiwan
| | - Edward Yi-Yung Yu
- Department of Radiology, Taitung MacKay Memorial Hospital, Taitung, Taiwan
| | - Sho-Ting Hung
- Department of Radiology, Taitung MacKay Memorial Hospital, Taitung, Taiwan
| | - Chia-Ying Chu
- Department of Pathology, Taitung MacKay Memorial Hospital, Taitung, Taiwan
| | - Kung-Liahng Wang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Nursing, MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taitung MacKay Memorial Hospital, Taitung, Taiwan; Department of Obstetrics and Gynecology, MacKay Medical College, New Taipei City, Taiwan.
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Abstract
BACKGROUND Patients with lymphedema refractory to medical treatment often have unrealistic expectations for lymphedema surgery. The purpose of this study was to assess patient expectations following lymphedema surgery. METHODS Patients presenting to the clinic for initial evaluation for lymphedema surgery were offered to complete a survey designed to evaluate their expectations for limb appearance, limb function, and overall well-being following lymphedema surgery. The patients were instructed to score each item using a five-point scale for improvement. A mean expectation score was calculated, which was then used to estimate the effects of preoperative variables on patients expectations using multiple regression analysis. RESULTS A total of 21 women and two men with a mean age of 60 years completed the survey. The upper limbs were affected in 10 patients and the lower limbs were affected in 13 patients. Physicians were the initial source of information about lymphedema surgery as a potential treatment option in 10 patients (43 percent), and a majority of the patients [n = 15 (65.2 percent)] thought that the physicians had fair or poor knowledge about lymphedema surgery. Significant or complete improvement was expected by 43.4 to 73.9 percent of patients. Patients' level of education, the disease duration, and the initial source of information about lymphedema surgery had a statistically significant impact on patients' expectations. CONCLUSIONS Early data suggest that most patients learn about lymphedema surgery from nonphysicians, with many expecting complete or significant improvement of lymphedema-associated symptoms with surgery. These findings emphasize the importance of addressing patient expectations and providing appropriate counseling before surgery.
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Japan Society of Gynecologic Oncology guidelines 2017 for the treatment of uterine cervical cancer. Int J Clin Oncol 2018; 24:1-19. [DOI: 10.1007/s10147-018-1351-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 09/30/2018] [Indexed: 10/28/2022]
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Kan Y, Dong D, Zhang Y, Jiang W, Zhao N, Han L, Fang M, Zang Y, Hu C, Tian J, Li C, Luo Y. Radiomic signature as a predictive factor for lymph node metastasis in early-stage cervical cancer. J Magn Reson Imaging 2018; 49:304-310. [PMID: 30102438 DOI: 10.1002/jmri.26209] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/12/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Lymph node metastasis (LNM) is the principal risk factor for poor outcomes in early-stage cervical cancer. Radiomics may offer a noninvasive way for predicting the stage of LNM. PURPOSE To evaluate a radiomic signature of LN involvement based on sagittal T1 contrast-enhanced (CE) and T2 MRI sequences. STUDY TYPE Retrospective. POPULATION In all, 143 patients were randomly divided into two primary and validation cohorts with 100 patients in the primary cohort and 43 patients in the validation cohort. FIELD STRENGTH/SEQUENCE T1 CE and T2 MRI sequences at 3T. ASSESSMENT The gold standard of LN status was based on histologic results. A radiologist with 10 years of experience used the ITK-SNAP software for 3D manual segmentation. A senior radiologist with 15 years of experience validated all segmentations. The area under the receiver operating characteristics curve (ROC AUC), classification accuracy, sensitivity, and specificity were used between LNM and non-LNM groups. STATISTICAL TESTS A total of 970 radiomic features and seven clinical characteristics were extracted. Minimum redundancy / maximum relevance and support vector machine algorithms were applied to select features and construct a radiomic signature. The Mann-Whitney U-test and the chi-square test were used to test the performance of clinical characteristics and potential prognostic outcomes. The results were used to assess the quantitative discrimination performance of the SVM-based radiomic signature. RESULTS The radiomic signatures allowed good discrimination between LNM and non-LNM groups. The ROC AUC was 0.753 (95% confidence interval [CI], 0.656-0.850) in the primary cohort and 0.754 (95% CI, 0584-0.924) in the validation cohort. DATA CONCLUSIONS A multiple-sequence MRI radiomic signature can be used as a noninvasive biomarker for preoperative assessment of LN status and potentially influence the therapeutic decision-making in early-stage cervical cancer patients. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:304-310.
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Affiliation(s)
- Yangyang Kan
- Dalian Medical University, Dalian, P.R. China.,Cancer Hospital of China Medical University, Shenyang, P.R. China.,Liaoning Cancer Hospital & Institute, Shenyang, P.R. China
| | - Di Dong
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, P.R. China.,University of Chinese Academy of Sciences, Beijing, P.R. China
| | - Yuchen Zhang
- University of Electronic Science and Technology of China, Chengdu, Sichuan, P.R. China
| | - Wenyan Jiang
- Cancer Hospital of China Medical University, Shenyang, P.R. China.,Liaoning Cancer Hospital & Institute, Shenyang, P.R. China
| | - Nannan Zhao
- Cancer Hospital of China Medical University, Shenyang, P.R. China.,Liaoning Cancer Hospital & Institute, Shenyang, P.R. China
| | - Lu Han
- Cancer Hospital of China Medical University, Shenyang, P.R. China.,Liaoning Cancer Hospital & Institute, Shenyang, P.R. China
| | - Mengjie Fang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, P.R. China.,University of Chinese Academy of Sciences, Beijing, P.R. China
| | - Yali Zang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, P.R. China.,University of Chinese Academy of Sciences, Beijing, P.R. China
| | - Chaoen Hu
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, P.R. China.,University of Chinese Academy of Sciences, Beijing, P.R. China
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, P.R. China.,University of Chinese Academy of Sciences, Beijing, P.R. China
| | - Chunming Li
- University of Electronic Science and Technology of China, Chengdu, Sichuan, P.R. China
| | - Yahong Luo
- Dalian Medical University, Dalian, P.R. China.,Cancer Hospital of China Medical University, Shenyang, P.R. China.,Liaoning Cancer Hospital & Institute, Shenyang, P.R. China
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Soergel P, Kirschke J, Klapdor R, Derlin T, Hillemanns P, Hertel H. Sentinel lymphadenectomy in cervical cancer using near infrared fluorescence from indocyanine green combined with technetium-99m-nanocolloid. Lasers Surg Med 2018; 50:994-1001. [DOI: 10.1002/lsm.22999] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Philipp Soergel
- Department of Obstetrics and Gynaecology; Hannover Medical School; Hannover Germany
| | - Johanna Kirschke
- Department of Obstetrics and Gynaecology; Hannover Medical School; Hannover Germany
| | - Rüdiger Klapdor
- Department of Obstetrics and Gynaecology; Hannover Medical School; Hannover Germany
| | - Thorsten Derlin
- Department of Nuclear Medicine; Hannover Medical School; Hannover Germany
| | - Peter Hillemanns
- Department of Obstetrics and Gynaecology; Hannover Medical School; Hannover Germany
| | - Hermann Hertel
- Department of Obstetrics and Gynaecology; Hannover Medical School; Hannover Germany
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Incidence of Lymph Node Metastases in Women With Low-Risk Early Cervical Cancer (<2 cm) Without Lymph-Vascular Invasion. Int J Gynecol Cancer 2018. [DOI: 10.1097/igc.0000000000001236] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveTo determine the incidence of lymph node metastasis in women with low-risk cervical cancer stage IA2 or IB1 (<2 cm) without lymph-vascular space invasion.MethodsA multicenter retrospective study was performed in patients who underwent radical or simple hysterectomy, conization, or trachelectomy plus pelvic lymphadenectomy for cervical cancer between January 2000 and June 2016.ResultsA total of 271 patients were included in the study. Median age and body mass index were 46 years (range, 23–77 years) and 24 kg/m2 (range, 18–48 kg/m2), respectively. Twenty-two patients had stage IA2 (8.1%), and 249 (91.9%) had stage IB1. The median tumor size was 14 mm (range, 5–20 mm). Tumor grades were 1 (n = 63 [23.2%]), 2 (n = 120 [44.3%]), 3 (n = 63 [23.2%]), and unknown (25 [9.2%]). Median depth stromal invasion was 6 mm (range, 3–20 mm). Histologic subtypes included squamous (n = 171 [63.1%]), adenocarcinoma (n = 92 [33.9%]), and adenosquamous (n = 8 [3.0%]). Overall incidence of lymph node metastasis was 2.9% (n = 8). The incidence of lymph node involvement in G1, G2, and G3 was 0% (0/63), 5% (6/120), and 3.1% (2/63), respectively. No patient with stage IA2 (regardless of grade or histology) or G1 cervical cancer less than 2 cm (stage IB1) had lymph node metastasis.ConclusionsPatients with stage IA2 or IB1 (G1) with tumor size of less than 2 cm and no lymph-vascular space invasion may not need lymph node evaluation. On the other hand, 95% and 98% of patients with grade 2 or 3 tumors, respectively, could potentially undergo an unnecessary lymphadenectomy. Further studies with bigger sample size are required to confirm these results.
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Abstract
Background: Cervical cancer is the second most common type of cancer among women. Effective screening programs can help
cancer detection in early phases and reduce death. Metastasis to lymph nodes is one of the most prognostic factors in patients who
underwent surgery. Also, a positive result from pathology report alert oncologist as a cause of death. Sentinel lymph node biopsy has
been widely studied and clinically used for many types of cancer.
Methods: Two techniques exist for detecting sentinel node in cervical cancer, which are Blue dye and gamma probe with radioactive
isotope (99mTc). Moreover, lymphoscintigraphy has many advantages over the stain method. Detecting the sentinel node is performed
via laparoscopy or laparotomy; former method is better and more accurate.
Results: Various researchers have focused on this method and its positive results; its superiority against full lymphadenectomy has
been declared in previous studies. Moreover, the role of sentinel lymph nodes biopsy in cervical cancer is still being extensively studied.
Sentinel lymph nodes (SLN) method has a higher accuracy level to detect metastasis.
Conclusion: Hence, it can be considered as a more appropriate alternative for pelvic lymph node dissection (PLND), which is a
standard technique. Altering the method to a standard clinical method needs in-depth researches and studies.
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30
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The combination of preoperative PET/CT and sentinel lymph node biopsy in the surgical management of early-stage cervical cancer. J Cancer Res Clin Oncol 2017; 143:2275-2281. [DOI: 10.1007/s00432-017-2467-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 06/23/2017] [Indexed: 12/20/2022]
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Ferrandina G, Pedone Anchora L, Gallotta V, Fagotti A, Vizza E, Chiantera V, De Iaco P, Ercoli A, Corrado G, Bottoni C, Fanfani F, Scambia G. Can We Define the Risk of Lymph Node Metastasis in Early-Stage Cervical Cancer Patients? A Large-Scale, Retrospective Study. Ann Surg Oncol 2017; 24:2311-2318. [PMID: 28608117 DOI: 10.1245/s10434-017-5917-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy has emerged as one of the most appreciated techniques for reducing the rate of complete lymph node dissection (LND) performed in patients with early-stage cervical cancer (ECC). However, its performances are still a matter of debate and, to improve them, international guidelines recommend performing at least unilateral LND in case of SLN mapping. In a prior study, we identified a group of patients without evidence of lymph node metastasis (LNM). Our objective is to define a precise risk of LNM for each ECC patient in order to significantly tailor surgery for ECC. METHODS Clinical and pathological data of ECC patients were retrospectively collected by eight Italian institutions. Chi-square test or Fisher's exact test along with logistic regression analysis was used to determine the association of each variable between patients with or without LNM. Results of logistic regression have been used as a basis to calculate the probability to harboring LNM. RESULTS A total of 463 ECC patients were identified. No LNM was detected among the 161 (34.8%) patients who met the criteria and were defined as Very Low Risk. In the other 302 patients, the precise risk of LNM was calculated, and it was <1% in 31 (10.3%) patients. CONCLUSIONS Defining the precise risk of LNM could lead to proper selection of patients in whom any lymph nodal procedure, including SLN, could be avoided.
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Affiliation(s)
- Gabriella Ferrandina
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy. .,Institute of Obstetrics/Gynecology, Catholic University of Sacred Heart, Rome, Italy.
| | - Luigi Pedone Anchora
- Institute of Obstetrics/Gynecology, Catholic University of Sacred Heart, Rome, Italy
| | - Valerio Gallotta
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy
| | - Anna Fagotti
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy.,Institute of Obstetrics/Gynecology, Catholic University of Sacred Heart, Rome, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Oncological Surgery, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Vito Chiantera
- Division of Gynecologic Oncology, Fondazione "Giovanni Paolo II", Campobasso, Italy
| | - Pierandrea De Iaco
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Alfredo Ercoli
- Department of Obstetrics and Gynecology, University of Eastern Piedmond, Novara, Italy
| | - Giacomo Corrado
- Gynecologic Oncology Unit, Department of Oncological Surgery, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Carolina Bottoni
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy
| | - Francesco Fanfani
- Department of Medicine and Aging Sciences, University "G. D'Annunzio", Chieti, Pescara, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy.,Institute of Obstetrics/Gynecology, Catholic University of Sacred Heart, Rome, Italy
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Ouyang F, Liu J, Xia M, Lin C, Wu X, Ye L, Song L, Li J, Wang J, Guo P, He M. GINS2 is a novel prognostic biomarker and promotes tumor progression in early-stage cervical cancer. Oncol Rep 2017; 37:2652-2662. [PMID: 28405687 PMCID: PMC5428920 DOI: 10.3892/or.2017.5573] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/16/2016] [Indexed: 12/15/2022] Open
Abstract
GINS complex subunit 2 (GINS2), a member of the GINS complex, is involved in DNA replication. GINS2 is upregulated in a variety of aggressive tumors. However, its role in cervical cancer carcinogenesis remains to be elucidated. We investigated the clinical significance of GINS2 in patients with early-stage cervical cancer and its biological functions in cervical cancer progression. GINS2 expression was analyzed in cervical cancer cell lines and in 8 matched cervical cancer samples at the mRNA and protein levels using real-time PCR and western blotting, respectively. GINS2 protein expression in 155 paraffin-embedded cervical cancer specimens was validated using immunohistochemistry. Statistical analysis was used to evaluate its clinicopathological significance. Short hairpin RNA interference, anchorage-independent growth ability, colony formation assay, wound healing ability, Transwell assays and western blotting were used to determine the effects of GINS2 on the aggressive phenotype of cervical cancer cells. There was obvious upregulation of GINS2 in the cervical cancer cell lines and tumor specimens compared to that in the normal cervical tissues. Significant correlations were identified between GINS2 expression and squamous cell carcinoma antigen (SCC-Ag; P<0.001), deep stromal invasion (P=0.021), vital status (P<0.001), recurrence (P<0.001) and pelvic lymph node metastasis (PLNM; P<0.001). Moreover, patients with higher GINS2 expression had shorter overall survival (OS) compared to patients with low GINS2 expression. Multivariate analysis revealed that GINS2 may serve as an independent risk factor of poor prognosis in early-stage cervical cancer. In addition, GINS2 downregulation markedly suppressed cell proliferation and tumorigenic ability, as well as cell migration and invasion. Our findings suggest that GINS2 is a novel indicator of PLNM and a valuable prognostic biomarker in early-stage cervical cancer, and subsequently is a valuable molecular target for cervical cancer diagnosis and treatment.
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Affiliation(s)
- Fei Ouyang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Junling Liu
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Meng Xia
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Chuyong Lin
- State Key Laboratory of Oncology in Southern China, Department of Experimental Research, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Xianqiu Wu
- State Key Laboratory of Oncology in Southern China, Department of Experimental Research, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Liping Ye
- State Key Laboratory of Oncology in Southern China, Department of Experimental Research, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Libing Song
- State Key Laboratory of Oncology in Southern China, Department of Experimental Research, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Jun Li
- Department of Biochemistry, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, P.R. China
| | - Jing Wang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Peng Guo
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Mian He
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
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Son HM, Kim SH, Kwon BR, Kim MJ, Kim CS, Cho SH. Preoperative prediction of suboptimal resection in advanced ovarian cancer based on clinical and CT parameters. Acta Radiol 2017; 58:498-504. [PMID: 27439399 DOI: 10.1177/0284185116658683] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background Cytoreduction is important as a survival predictor in advanced ovarian cancer. Purpose To determine the prediction of suboptimal resection (SOR) in advanced ovarian cancer based on clinical and computed tomography (CT) parameters. Material and Methods Between 2007 and 2015, 327 consecutive patients with FIGO stage III-IV ovarian cancer and preoperative CT were included. During 2007-2012, patients were assigned to a derivation dataset ( n = 220) and the others were assigned to a validation dataset ( n = 107). Clinical parameters were reviewed and two radiologists assessed the presence or absence of tabulated parameters on CT images. Logistic regression analyses based on area under the receiver-operating characteristic curve (AUROC) were performed to identify variables predicting SOR, and generated simple score using Cox proportional hazards model. Results There was no statistical difference in patients' characteristics in both datasets, except for residual disease ( P = 0.001). Optimal resection improved from 45.0% (99/220) in the derivation dataset to 64.4% (69/107) in the validation dataset. Logistic regression identified that Eastern Cooperative Oncology Group-performance status (ECOG-PS 2), involvements of peritoneum, diaphragm, bowel mesentery and suprarenal lymph nodes, and pleural effusion were independent variables of SOR. Overall AUROC for score predicting SOR was 0.761 with sensitivity, specificity, and positive and negative predictive values of 70.6%, 73.2%, 68.7%, and 91.9%, respectively. In the derivation dataset, AUROC was 0.792, with sensitivity of 71.4% and specificity of 74.3%, and AUROC of 0.758 with sensitivity of 69.2% and specificity of 72.8% in the validation dataset. Conclusion CT may be a useful preoperative predictor of SOR in advanced ovarian cancer.
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Affiliation(s)
- Hye Min Son
- Department of Radiology, Dongsan Hospital, Keimyung University, Daegu, Republic of Korea
| | - See Hyung Kim
- Department of Radiology, Dongsan Hospital, Keimyung University, Daegu, Republic of Korea
| | - Bo Ra Kwon
- Department of Radiology, Dongsan Hospital, Keimyung University, Daegu, Republic of Korea
| | - Mi Jeong Kim
- Department of Radiology, Dongsan Hospital, Keimyung University, Daegu, Republic of Korea
| | - Chan Sun Kim
- Department of Radiology, Dongsan Hospital, Keimyung University, Daegu, Republic of Korea
| | - Seung Hyun Cho
- Department of Radiology, National University Hospital, Kyungbook National University Hospital, Daegu, Republic of Korea
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Brar H, Hogen L, Covens A. Cost-effectiveness of sentinel node biopsy and pathological ultrastaging in patients with early-stage cervical cancer. Cancer 2017; 123:1751-1759. [DOI: 10.1002/cncr.30509] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 11/07/2016] [Accepted: 11/21/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Harinder Brar
- Division of Gynecological Oncology; Department of Obstetrics and Gynecology, University of Toronto; Toronto Ontario Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto; Toronto Ontario Canada
- Division of Gynecological Oncology; Odette Cancer Center, Sunnybrook Hospital; Toronto Ontario Canada
| | - Liat Hogen
- Division of Gynecological Oncology; Department of Obstetrics and Gynecology, University of Toronto; Toronto Ontario Canada
- Division of Gynecological Oncology; Odette Cancer Center, Sunnybrook Hospital; Toronto Ontario Canada
| | - Al Covens
- Division of Gynecological Oncology; Department of Obstetrics and Gynecology, University of Toronto; Toronto Ontario Canada
- Division of Gynecological Oncology; Odette Cancer Center, Sunnybrook Hospital; Toronto Ontario Canada
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Ikeda Y, Furusawa A, Kitagawa R, Tokinaga A, Ito F, Ukita M, Nomura H, Yamagami W, Tanabe H, Mikami M, Takeshima N, Yaegashi N. Practice patterns of adjuvant therapy for intermediate/high recurrence risk cervical cancer patients in Japan. J Gynecol Oncol 2016; 27:e29. [PMID: 27029750 PMCID: PMC4823360 DOI: 10.3802/jgo.2016.27.e29] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 12/26/2015] [Accepted: 01/05/2016] [Indexed: 11/30/2022] Open
Abstract
Objective Although radiation therapy (RT) and concurrent chemoradiotherapy (CCRT) are the global standards for adjuvant therapy treatment in cervical cancer, many Japanese institutions choose chemotherapy (CT) because of the low frequency of irreversible adverse events. In this study, we aimed to clarify the trends of adjuvant therapy for intermediate/high-risk cervical cancer after radical surgery in Japan. Methods A questionnaire survey was conducted by the Japanese Gynecologic Oncology Group to 186 authorized institutions active in the treatment of gynecologic cancer. Results Responses were obtained from 129 facilities. Adjuvant RT/CCRT and intensity-modulated RT were performed in 98 (76%) and 23 (18%) institutions, respectively. On the other hand, CT was chosen as an alternative in 93 institutions (72%). The most common regimen of CT, which was used in 66 institutions (51%), was a combination of cisplatin/carboplatin with paclitaxel. CT was considered an appropriate alternative option to RT/CCRT in patients with risk factors such as bulky tumors, lymph node metastasis, lymphovascular invasion, parametrial invasion, and stromal invasion. The risk of severe adverse events was considered to be lower for CT than for RT/CCRT in 109 institutions (84%). Conclusion This survey revealed a variety of policies regarding adjuvant therapy among institutions. A clinical study to assess the efficacy or non-inferiority of adjuvant CT is warranted.
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Affiliation(s)
- Yuji Ikeda
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan.,Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Akiko Furusawa
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryo Kitagawa
- Department of Obstetrics and Gynecology, NTT Medical Center Tokyo, Tokyo, Japan.
| | - Aya Tokinaga
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Fuminori Ito
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | - Masayo Ukita
- Department of Obstetrics and Gynecology, Kinki University Faculty of Medicine, Osakasayama, Japan
| | - Hidetaka Nomura
- Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan
| | - Wataru Yamagami
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Tanabe
- Department of Obstetrics and Gynecology, Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan
| | | | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Location of Sentinel Lymph Node in Cervical Carcinoma and Factors Associated With Unilateral Detection. Int J Gynecol Cancer 2016; 25:1663-8. [PMID: 26270124 DOI: 10.1097/igc.0000000000000539] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The aims of this study were to assess locality of the sentinel lymph node (SLN) in cervical carcinoma and examine factors affecting bilateral SLN detection. METHODS This was a retrospective review of SLN data (anatomical location, count and laterality) in patients with early-stage cervical cancer (International Federation of Gynecology and Obstetrics stage IA1 with lymphovascular space invasion to stage IIA) using intraoperative gamma probe and blue dye. The preoperative single-photon emission computed tomography with computed tomography was used to detect laterality, number of the SLNs, and rare locations. Patients were treated between January 2005 to January 2015 at the West Kent Gynaecological Oncology Centre, Maidstone Hospital, Maidstone, United Kingdom. RESULTS A total of 132 women were investigated. The most common SLN location was the external iliac (38.6%) followed by obturator (25.3%) and internal iliac (23.6%) regions. A small percentage was identified in presacral (1.4%) and para-aortic regions (0.7%). Older age (P = 0.01) and an elevated body mass index (P = 0.03) were associated with decreased SLN count by preoperative single-photon emission computed tomography with computed tomography, and only age affected SLN count by gamma probe (P = 0.01). Initial surgery, large loop excision of the transformation zone, or cone biopsy of the cervix had no effect on SLN count. There was no difference observed in bilateral detection with respect to surgical approach (open: n = 48/laparoscopic: n = 84). However, older age was independently associated with a decrease in bilateral SLN detection (P = 0.003). In these patients who underwent unilateral full pelvic lymphadenectomy, all the nonsentinel nodes were negative. CONCLUSIONS The majority of SLNs were located in the external iliac, obturator, and internal iliac regions. Both older age and an elevated body mass index were associated with a reduced SLN count. Unilateral detection of SLN was independently associated with older age, which may be due to sclerosis in the lymphatic vessels or reduced perfusion in the pelvis in these women. If no SLN is detected on one side, the consensus is to perform a full pelvic lymphadenectomy on that side of the pelvis.
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Wang Y, Yao T, Yu J, Li J, Chen Q, Lin Z. Can pelvic lymphadenectomy be omitted in patients with stage IA2, IB1, and IIA1 squamous cell cervical cancer? SPRINGERPLUS 2016; 5:1262. [PMID: 27536545 PMCID: PMC4974207 DOI: 10.1186/s40064-016-2927-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 07/27/2016] [Indexed: 11/29/2022]
Abstract
Purpose This study aimed to identify the surgical-pathologic risk factors of lymph node metastasis (LNM) in patients with early stage squamous cell cervical cancer and to evaluate the potential efficacy of omitting pelvic lymphadenectomy. Methods A total of 276 patients with stage IA2, IB1, and IIA1 squamous cell cervical cancer receiving primary radical hysterectomy with pelvic lymphadenectomy were included in this study. Results The incidences of LNM in patients with stage IA2, IB1, and IIA1 squamous cell cervical cancer were 0 % (0/8), 17.4 % (36/207), and 29.5 % (18/61), respectively. The most common location of LNM was the obturator lymph node. Human papilloma virus 16 subtype was the most common infection in early stage squamous cell cervical cancer. Univariate analysis revealed that squamous cell carcinoma antigen (SCCAg) greater than 1.5 μg/L (p < 0.001), tumor size greater than 2 cm (p < 0.001), tumor size greater than 3 cm (p < 0.001), depth of stromal invasion (p < 0.001) and lymphovascular invasion (p < 0.001) were associated with LNM. Logistic regression analysis revealed that depth of stromal invasion {model 1 [p = 0.006; odds ratio (OR) 2.161; 95 % confidence interval (CI) 1.251–3.734], model 2 [p = 0.002; OR 2.344; 95 % CI 1.337–3.989]}, lymphovascular invasion [model 1 (p = 0.004; OR 2.967; 95 % CI 1.411–6.237), model 2 (p = 0.004; OR 2.978; 95 % CI 1.421–6.243)], and SCCAg greater than 1.5 μg/L [model 1 (p = 0.023; OR 2.431; 95 % CI 1.129–5.235), model 2 (p = 0.024; OR 2.418; 95 % CI 1.125–5.194)] were independently associated with LNM. Conclusions Pelvic lymphadenectomy may be omitted in patients with SCCAg lower than 1.5 μg/L, superficial stromal invasion and without lymphovascular invasion in stage IA2, IB1, IIA1 squamous cell cervical cancer.
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Affiliation(s)
- Yaxian Wang
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, 510120 People's Republic of China.,Xiamen Cancer Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003 People's Republic of China
| | - Tingting Yao
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, 510120 People's Republic of China
| | - Jin Yu
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, 510120 People's Republic of China
| | - Jing Li
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, 510120 People's Republic of China
| | - Qionghua Chen
- Xiamen Cancer Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003 People's Republic of China
| | - Zhongqiu Lin
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, 510120 People's Republic of China
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Ferreira H, Nogueira-Silva C, Miranda A, Correia-Pinto J. Resection of Sentinel Lymph Nodes by an Extraperitoneal Minilaparoscopic Approach Using Indocyanine Green for Uterine Malignancies. Surg Innov 2016; 23:347-53. [DOI: 10.1177/1553350615620302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. The sentinel lymph node (SLN) concept might minimize surgical aggressiveness in cervical and endometrial malignancies. The aim of the study was to test the feasibility and reliability of minilaparoscopic extraperitoneal SLN excision after indocyanine green (ICG) cervical injection using a high-definition near infrared (NIR) imaging system in an in vivo porcine model. The same procedure was performed using conventional laparoscopic instruments and both outcomes were compared. Methods. Twenty-four animals were equally and randomly divided into a minilaparoscopic group (group A) and a 5-mm conventional laparoscopic group (group B). A high-definition NIR imaging system and a 30° ICG endoscope were used. First, ICG (0.5 mL) was injected in the paracervical region. The SLN coloring time was recorded. An extraperitoneal approach to the SLN was executed with the same CO2 retropneumoperitoneum pressures (10 mm Hg). In both groups, the times for SLN localization and excision, as well as complications, were registered. Finally, a laparotomy was then done to evaluate whether any stained SLN still remained. The same surgical team performed all experiments. Results. SLNs were identified and extraperitoneally excised in all animals without major complications. The SLN localization varied between animals from external iliac to preaortic regions. The surgical times were shorter with minilaparoscopy (39.3 ± 13 minutes) than with conventional 5-mm instruments (51.3 ± 14.17 minutes; P = .042). In group B, one stained SLN remained and was only detected by laparotomy. Conclusions. We confirmed the feasibility and reliability of extraperitoneal minilaparoscopic approach for identification, dissection, and excision of SLN using an NIR imaging system and ICG.
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Affiliation(s)
- Hélder Ferreira
- University of Minho, Braga, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, Braga, Portugal
- Centro Hospitalar do Porto, Porto, Portugal
| | - Cristina Nogueira-Silva
- University of Minho, Braga, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, Braga, Portugal
- Hospital de Braga, Braga, Portugal
| | - Alice Miranda
- University of Minho, Braga, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, Braga, Portugal
| | - Jorge Correia-Pinto
- University of Minho, Braga, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, Braga, Portugal
- Hospital de Braga, Braga, Portugal
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Fagotti A, Pedone Anchora L, Conte C, Chiantera V, Vizza E, Tortorella L, Surico D, De Iaco P, Corrado G, Fanfani F, Gallotta V, Scambia G. Beyond sentinel node algorithm. Toward a more tailored surgery for cervical cancer patients. Cancer Med 2016; 5:1725-30. [PMID: 27230108 PMCID: PMC4971900 DOI: 10.1002/cam4.722] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 02/29/2016] [Accepted: 03/09/2016] [Indexed: 12/17/2022] Open
Abstract
Nowadays cervical cancer is frequently diagnosed at early stage. For these patients lymph node metastasis (LNM) is considered the most important prognostic factor. During the last decade many efforts have been made to reduce rate of complications associated with lymphadenectomy (LND). A great interest has arisen in sentinel lymph node (SLN) biopsy as a technique able to decrease number of LND performed and, at the same time, to assess lymph nodal status. High diagnostic performances have been reached thanks to SLN surgical algorithm. However, despite the efforts, about 25% of these patients undergo at least unilateral LND to meet NCCN recommendations. Data of women with International Federation of Gynecology and Obstetrics stage IA1‐IB1/IIA1 cervical carcinoma were retrospectively collected by six Italian institutions. All patients underwent complete preoperative staging workup and were primarily treated by radical hysterectomy and pelvic bilateral LND. A total of 368 patients with early‐stage cervical cancer were identified. Among them 333 (90.5%) showed no suspicious enlarged nodes at the preoperative magnetic resonance imaging (MRI). In this subset, tumor diameter ≥20 mm was the only independent predictor of LN status (P = 0.003). None of the 106 patients with negative MRI nodal assessment, with squamous and adenosquamous histotype and a tumor diameter less than 2 cm had LNM. Based on these results we propose a new modified SLN surgical algorithm that could safely reduce LND performed in patients with very low‐risk early‐stage cervical cancer.
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Affiliation(s)
- Anna Fagotti
- Division of Minimally Invasive Gynaecology, St. Maria Hospital, University of Perugia, Terni, Italy
| | - Luigi Pedone Anchora
- Gynecologic Oncology Unit, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Carmine Conte
- Gynecologic Oncology Unit, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Vito Chiantera
- Division of Gynecologic Oncology, Department of Oncology, Foundation John Paul II, Catholic University of the Sacred Heart, Campobasso, Italy
| | - Enrico Vizza
- Gynecology Oncology Unit, Department of Oncological Surgery, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Lucia Tortorella
- Gynecologic Oncology Unit, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Daniela Surico
- Department of Obstetrics and Gynecology, University of Eastern Piedmont, Novara, Italy
| | - Pierandrea De Iaco
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Giacomo Corrado
- Gynecology Oncology Unit, Department of Oncological Surgery, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Francesco Fanfani
- Gynecologic Oncology Unit, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Valerio Gallotta
- Gynecologic Oncology Unit, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
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Jung PS, Kim DY, Lee SW, Park JY, Suh DS, Kim JH, Kim YM, Kim YT, Nam JH. Clinical Role of Adjuvant Chemotherapy after Radical Hysterectomy for FIGO Stage IB-IIA Cervical Cancer: Comparison with Adjuvant RT/CCRT Using Inverse-Probability-of-Treatment Weighting. PLoS One 2015; 10:e0132298. [PMID: 26176626 PMCID: PMC4503636 DOI: 10.1371/journal.pone.0132298] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/11/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the clinical role of adjuvant chemotherapy (AC) in FIGO stage IB-IIA cervical cancer patients. STUDY DESIGN A cohort of 262 patients with cervical cancer who received radical hysterectomy (RH) and adjuvant therapy at Asan Medical Center between 1992 and 2012 was enrolled. In this cohort, 85 patients received adjuvant chemotherapy (AC), and 177 received adjuvant radiotherapy or concurrent chemoradiation therapy (AR). Oncologic outcomes and adverse events in both treatment arms were compared using weighted Cox proportional hazards regression models with inverse-probability-of-treatment weighting (IPTW) to reduce the impact of treatment selection bias and potential confounding factors. RESULTS During a 46.8-month median follow-up duration, 39 patients (14.9%) had recurrences, and 18 patients (6.9%) died of disease. In multivariate analysis, the hazard ratio (HR) for recurrence and death was not significantly different in patients in either treatment arm (p=0.62 and 0.12, respectively). Also, after IPTW matching, the HR for recurrence did not significantly differ between the arms (HR 1.57, 95% CI 0.68-3.62, p=0.29). Similarly, disease-free survival and overall survival were not significantly different between the arms (p=0.47 and 0.13, respectively). In addition, patients with AC had a much lower prevalence of long-term complications (lymphedema: n=8 (9.4%) vs. 46 (26.0%), p=0.03; ureteral stricture: n=0 vs. 9 (6.2%), p=0.05). CONCLUSION Patients with FIGO stage IB-IIA cervical cancer can benefit from AC after RH with fewer long-term complications and non-inferior therapeutic effect to AR. Chemotherapy may therefore be an alternative adjuvant treatment option for cervical cancer, particularly in younger patients.
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Affiliation(s)
- Phill-Seung Jung
- Division of Gynecolgic Oncology, Department of Obstetrics and Gynecology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dae-Yeon Kim
- Division of Gynecolgic Oncology, Department of Obstetrics and Gynecology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Shin-Wha Lee
- Division of Gynecolgic Oncology, Department of Obstetrics and Gynecology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong-Yeol Park
- Division of Gynecolgic Oncology, Department of Obstetrics and Gynecology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dae-Shik Suh
- Division of Gynecolgic Oncology, Department of Obstetrics and Gynecology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong-Hyeok Kim
- Division of Gynecolgic Oncology, Department of Obstetrics and Gynecology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yong-Man Kim
- Division of Gynecolgic Oncology, Department of Obstetrics and Gynecology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young-Tak Kim
- Division of Gynecolgic Oncology, Department of Obstetrics and Gynecology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joo-Hyun Nam
- Division of Gynecolgic Oncology, Department of Obstetrics and Gynecology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
- * E-mail:
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Radical Trachelectomy for Early-Stage Cervical Cancer: A Survey of the Society of Gynecologic Oncology and Gynecologic Oncology Fellows-in-Training. Int J Gynecol Cancer 2015; 25:681-7. [DOI: 10.1097/igc.0000000000000397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
ObjectiveThe aim of this study was to survey gynecologic oncologists and fellows-in-training regarding the role of radical trachelectomy (RT) and conservative surgery in patients with early-stage cervical cancer.Materials and MethodsFrom June 2012 to September 2012, the Society of Gynecologic Oncology member practitioners (n = 1353) and gynecologic oncology fellows (n = 156) were sent group-specific surveys investigating current practice, training, and the future of RT for early-stage cervical cancer management.ResultsTwenty-two percent of practitioners (n = 303) and 24.4% of fellows (n = 38) completed the surveys. Of the practitioners, 50% (n = 148) report performing RT, 98% (n = 269) support RT as treatment for squamous carcinoma, and 71% (n = 195) confirm the use of RT for adenocarcinoma. Most practitioners offer RT treatment for stages IA2 to IB1 smaller than 2 cm (n = 209, 76.8%) regardless of grade (77.7%) or lymph vascular space invasion (n = 211, 79.3%). Only 8% (n = 23) of practitioners feel that RT is appropriate for stage IBI larger than 2 cm. Respectively, both practitioners and fellows most frequently perform robotic-assisted (47.0%, n = 101 and 59.1%, n = 13) and abdominal (40.5%, n = 87 and 68.2%, n = 15) RT approaches. After training, fellows project the use of robotic-assisted (71%, n = 22) or abdominal methods (58.1%, n = 18). Overall, 75% (n = 227) of practitioners and 60% (n = 23) of fellows speculate that over the next 5 years, less radical procedures will be used to manage early-stage cervical cancer.ConclusionsOur findings suggest that practitioners and fellows believe RT remains an option for early-stage cervical cancer patients. However, a significant proportion of all respondents believe that less radical surgery may be a future consideration for patients with low-risk early-stage cervical cancer.
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Hildebrandt MG, Kodahl AR, Teilmann-Jørgensen D, Mogensen O, Jensen PT. [18F]Fluorodeoxyglucose PET/Computed Tomography in Breast Cancer and Gynecologic Cancers. PET Clin 2015; 10:89-104. [DOI: 10.1016/j.cpet.2014.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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de Freitas RR, Baiocchi G, Hatschbach SBB, Linhares JC, Guerreiro JA, Minari CL, Ribeiro R, Jung J, Zukovski T, Lopes A. Can a Sentinel Node Mapping Algorithm Detect All Positive Lymph Nodes in Cervical Cancer? Ann Surg Oncol 2014; 22:1564-9. [DOI: 10.1245/s10434-014-4245-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Indexed: 11/18/2022]
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Value and advantages of preoperative sentinel lymph node imaging with SPECT/CT in cervical cancer. Int J Gynecol Cancer 2014; 24:295-302. [PMID: 24401983 DOI: 10.1097/igc.0000000000000032] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Precise detection of sentinel lymph nodes (SLNs) seems to be a crucial factor for optimized treatment of cervical cancer. We assess the use of single photon emission computed tomography combined with computed tomography (SPECT/CT) as an alternative to lymphoscintigraphy (LSG) for preoperative identification of SLN. METHODS This study was performed in a prospective, unicentric setting. Patients with cervical carcinoma were scheduled for surgery and additional SLN labeling by peritumoral injection of 10 MBq technetium-99m-nanocolloid and patent blue. Thirty minutes after injection, LSG and SPECT/CT were carried out. We evaluated the number of SLNs detected intraoperatively in LSG and SPECT/CT and the histologic findings of SLN and non-SLN. Subsequently, we determined the impact of these results on the therapeutic approach. RESULTS This represents the largest study about SPECT/CT for SLN detection in cervical cancer so far. Between August 2008 and March 2013, 59 cervical cancer patients underwent intraoperative SLN detection. In addition, 51 of these patients underwent preoperative LSG and SPECT/CT. Imaging with SPECT/CT detected singular SLN at significantly higher rate (47/51, 92.2%) than that with planar LSG (43/51, 84.3%, P = 0.044). Furthermore, SPECT/CT performed better than LSG regarding the total number of detected SLN (SPECT/CT median, 3 [0-18]; LSG median, 2 [0-15]) and detection rates per pelvic side (SPECT/CT 76.9%, LSG 69.2%, P < 0.01). Whenever SLN detection succeeded, histologic evaluation of SLN correctly predicted the lymph node status per patient's side. Using this type of diagnostic approach for lymph node staging, we reached sensitivity of 100% and negative predictive value of 100% at a rate of false-negative results of 0% even in tumors larger than 4 cm. CONCLUSIONS Single photon emission computed tomography combined with computed tomography imaging leads to improved rates of SLN detection and better anatomic correlation compared with planar LSG. Thus, intraoperative detection of SLN can be improved by preoperative SPECT/CT imaging. This enhances the clinical value of SLN technique and improves the oncologic safety of SLN concept.
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Sowa E, Kuhnt S, Hinz A, Schröder C, Deutsch T, Geue K. Postoperative Health-Related Quality of Life of Cervical Cancer Patients - A Comparison between the Wertheim-Meigs Operation and Total Mesometrial Resection (TMMR). Geburtshilfe Frauenheilkd 2014; 74:670-676. [PMID: 25100882 DOI: 10.1055/s-0034-1368600] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 05/14/2014] [Accepted: 05/20/2014] [Indexed: 01/16/2023] Open
Abstract
Introduction: The present study compares for the first time the standard therapy for cervical cancer in FIGO-stages IB-IIB, radical hysterectomy according to the Wertheim-Meigs operation, with the newly developed, nerve-sparing surgical technique, total mesometrial resection (TMMR) with regard to postoperative, health-related quality of life. Method: In the framework of a multicentre, retrospective cohort study a total of 110 cervical cancer patients were interviewed once by means of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the cervical cancer module (EORTC QLQ-CX24). The influence of the surgical method was investigated by analysis of covariance under control of age and the time elapsed between treatment and interview. Results: An influence of the therapeutic method was demonstrated in the EORTC scales physical function (p = 0.047), role function (p = 0.016), fatigue (p = 0.028), pain (p = 0.018), shortness of breath (p = 0.034), lack of appetite (p = 0.006) and diarrhoea (p = 0.012) in favour of the 74 women treated by TMMR. With regard to cognitive, emotional and social functioning as well as cervical cancer-specific symptoms, no significant differences between the therapy groups were found. Conclusion: The findings presented in this study suggest a superiority of TMMR in comparison to the previously employed radical hysterectomy according to Wertheim-Meigs with regard to the postoperative quality of life, especially in the fields of physical activity and fatigue. This needs to be validated in the course of prospective, multicentre studies. In addition, it must be clarified as to what extent the found effects are, in particular, due to the omission of an additional radiotherapy.
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Affiliation(s)
- E Sowa
- Klinik für Gynäkologie und Geburtshilfe, Klinikum St. Georg gGmbH Leipzig, Leipzig
| | - S Kuhnt
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig
| | - A Hinz
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig
| | - C Schröder
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig
| | - T Deutsch
- Selbständige Abteilung für Allgemeinmedizin, Universität Leipzig, Leipzig
| | - K Geue
- Department of Medical Psychology and Medical Sociology, University Leipzig, Leipzig
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[Sentinel lymph node in low stage cervical cancers. Current data. Quality assurance. Prospects]. Bull Cancer 2014; 101:349-53. [PMID: 24793625 DOI: 10.1684/bdc.2014.1928] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Sentinel node biopsy appears as a promising technique for the assessment of nodal disease in early cervical cancers. Selection of a population with a low risk of nodal metastasis, a minimal training, and simple rules allow a low false negative rate. Sentinel node biopsy provides supplementary information, such as anatomical information (nodes outside of routine lymphadenectomy areas) and histological information (isolated tumors cells and micrometastases).
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Sentinel lymph node biopsy in uterine cervical cancer patients: ready for clinical use? A review of the literature. ISRN SURGERY 2014; 2014:841618. [PMID: 24527233 PMCID: PMC3914400 DOI: 10.1155/2014/841618] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 12/11/2013] [Indexed: 11/18/2022]
Abstract
Sentinel lymph node biopsy has been widely studied in a number of cancer types. As far as cervical cancer is concerned, this technique has already been used, revealing both positive results and several issues to be solved. The debate on the role of sentinel lymph node biopsy in cervical cancer is still open although most of the studies have already revealed its superiority over complete lymphadenectomy and the best handling possible of the emerging practical problems. Further research should be made in order to standardize this method and include it in the clinical routine.
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Undurraga M, Loubeyre P, Dubuisson JB, Schneider D, Petignat P. Early-stage cervical cancer: is surgery better than radiotherapy? Expert Rev Anticancer Ther 2014; 10:451-60. [DOI: 10.1586/era.09.192] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Holman LL, Levenback CF, Frumovitz M. Sentinel lymph node evaluation in women with cervical cancer. J Minim Invasive Gynecol 2014; 21:540-5. [PMID: 24407177 DOI: 10.1016/j.jmig.2013.12.095] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 12/18/2013] [Accepted: 12/19/2013] [Indexed: 02/06/2023]
Abstract
Lymph node status is the most important prognosticator of survival in women with early stage cervical cancer. Thus many patients with cervical cancer will undergo pelvic lymphadenectomy as part of the treatment. This procedure is associated with substantial morbidity. Use of the sentinel lymph node technique in women with cervical cancer has the potential to decrease this morbidity. Multiple studies have suggested that sentinel lymph node mapping in these patients is feasible, with excellent detection rates and sensitivity. This review examines the current body of literature about sentinel lymph node biopsy in women with cervical cancer.
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Affiliation(s)
- Laura L Holman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD, Anderson Cancer Center, Houston
| | - Charles F Levenback
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD, Anderson Cancer Center, Houston
| | - Michael Frumovitz
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD, Anderson Cancer Center, Houston.
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