J 2024

Diagnostic performance of ultrasonography in pre-operative assessment of lymph nodes in patients with cervical cancer

FRUHAUF, Filip, David CIBULA, Roman KOCIAN, Michal ZIKAN, Pavel DUNDR et. al.

Basic information

Original name

Diagnostic performance of ultrasonography in pre-operative assessment of lymph nodes in patients with cervical cancer

Authors

FRUHAUF, Filip (203 Czech Republic), David CIBULA (203 Czech Republic), Roman KOCIAN (203 Czech Republic), Michal ZIKAN (203 Czech Republic), Pavel DUNDR (203 Czech Republic), Jiří JARKOVSKÝ (203 Czech Republic, belonging to the institution) and Daniela FISCHEROVA (203 Czech Republic)

Edition

International Journal of Gynecological Cancer, LONDON, BMJ PUBLISHING GROUP, 2024, 1048-891X

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30204 Oncology

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

Impact factor

Impact factor: 4.800 in 2022

Organization unit

Faculty of Medicine

DOI

UT WoS

001265086900013

Keywords in English

Cervical Cancer; Lymph Nodes; Lymphatic Metastasis; Area Under Curve

Tags

Tags

International impact, Reviewed
Změněno: 5/8/2024 13:12, Mgr. Tereza Miškechová

Abstract

V originále

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.