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@article{2421702,
author = {Fruhauf, Filip and Cibula, David and Kocian, Roman and Zikan, Michal and Dundr, Pavel and Jarkovský, Jiří and Fischerova, Daniela},
article_location = {LONDON},
article_number = {7},
doi = {http://dx.doi.org/10.1136/ijgc-2024-005341},
keywords = {Cervical Cancer; Lymph Nodes; Lymphatic Metastasis; Area Under Curve},
language = {eng},
issn = {1048-891X},
journal = {International Journal of Gynecological Cancer},
title = {Diagnostic performance of ultrasonography in pre-operative assessment of lymph nodes in patients with cervical cancer},
url = {https://ijgc.bmj.com/content/34/7/985},
volume = {34},
year = {2024}
}
TY - JOUR
ID - 2421702
AU - Fruhauf, Filip - Cibula, David - Kocian, Roman - Zikan, Michal - Dundr, Pavel - Jarkovský, Jiří - Fischerova, Daniela
PY - 2024
TI - Diagnostic performance of ultrasonography in pre-operative assessment of lymph nodes in patients with cervical cancer
JF - International Journal of Gynecological Cancer
VL - 34
IS - 7
SP - 985-992
EP - 985-992
PB - BMJ PUBLISHING GROUP
SN - 1048891X
KW - Cervical Cancer
KW - Lymph Nodes
KW - Lymphatic Metastasis
KW - Area Under Curve
UR - https://ijgc.bmj.com/content/34/7/985
N2 - Objectives To assess the diagnostic performance of ultrasonography in pre-operative assessment of lymph nodes in patients with cervical cancer, to compare the outcomes for pelvic and para-aortic regions, and to detect macrometastases and micrometastases separately. Methods Patients were retrospectively included if they met the following inclusion criteria: pathologically verified cervical cancer; ultrasonography performed by one of four experienced sonographers; surgical lymph node staging, at least in the pelvic region-sentinel lymph node biopsy or systematic pelvic lymphadenectomy or debulking. The final pathological examination was the reference standard. Results 390 patients met the inclusion criteria between 2009 and 2019. Pelvic node macrometastases (>= 2 mm) were confirmed in 54 patients (13.8%), and micrometastases (>= 0.2 mm and <2 mm) in another 21 patients (5.4%). Ultrasonography had sensitivity 72.2%, specificity 94.0%, and area under the curve (AUC) 0.831 to detect pelvic macrometastases, while sensitivity 53.3%, specificity 94.0%, and AUC 0.737 to detect both pelvic macrometastases and micrometastases (pN1). Ultrasonography failed to detect pelvic micrometastases, with sensitivity 19.2%, specificity 85.2%, and AUC 0.522. There was no significant impact of body mass index on diagnostic accuracy. Metastases in para-aortic nodes (macrometastases only) were confirmed in 16 of 71 patients who underwent para-aortic lymphadenectomy. Ultrasonography yielded sensitivity 56.3%, specificity 98.2%, and AUC 0.772 to identify para-aortic node macrometastases. Conclusion Ultrasonography performed by an experienced sonographer can be considered a sufficient diagnostic tool for pre-operative assessment of lymph nodes in patients with cervical cancer, showing similar diagnostic accuracy in detection of pelvic macrometastases as reported for other imaging methods (18F-fluorodeoxyglucose positron emission tomography/CT or diffusion-weighted imaging/MRI). It had low sensitivity for detection of small-volume macrometastases (largest diameter <5 mm) and micrometastases. The accuracy of para-aortic assessment was comparable to that for pelvic lymph nodes, and assessment of the para-aortic region should be an inseparable part of the examination protocol.
ER -
FRUHAUF, Filip, David CIBULA, Roman KOCIAN, Michal ZIKAN, Pavel DUNDR, Jiří JARKOVSKÝ and Daniela FISCHEROVA. Diagnostic performance of ultrasonography in pre-operative assessment of lymph nodes in patients with cervical cancer. \textit{International Journal of Gynecological Cancer}. LONDON: BMJ PUBLISHING GROUP, 2024, vol.~34, No~7, p.~985-992. ISSN~1048-891X. Available from: https://dx.doi.org/10.1136/ijgc-2024-005341.
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