Surgical or imaging lymph node assessment in locally advanced cervical cancer: a systematic review and meta-analysis

Abstract

Objective To evaluate the survival impact of imaging vs surgical nodal assessment in patients with cervical cancer stage IB2–IVA prior to definitive chemoradiotherapy (CRT). Methods PubMed, MEDLINE, Cochrane Library, and ClinicalTrials.gov were used to search for publications in English and Chinese over a 50-year period. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols was used to conduct this review. Inclusion criteria were studies that compared survival outcomes in International Federation of Gynecology and Obstetrics 2009 stage IB2–IVA cervical cancer patients with pre-therapy pelvic and/or aortic lymphadenectomy (LND) or imaging. One or more of the following modalities were used for nodal assessment: computed tomography (CT), magnetic resonance imaging, or positron emission tomography-CT. The National Institutes of Health Quality Assessment Tool was utilized to assess study quality. Results The initial search identified 65 studies, and five met the inclusion criteria. There were a total of 1,112 patients. Seven hundred and fifty-four underwent pelvic and/or aortic LND and 358 had imaging. When compared to LND, imaging had a sensitivity and specificity of 88.9% and 22.2% for pelvic lymph node (LN), and 33%–62.5% and 92%–95.5% for para-aortic LN. There were no differences in progression-free survival (PFS) (hazard ratio [HR]=1.13; 95% confidence interval [CI]=0.73–1.74; I 2 =75%; p<0.01) and overall survival (OS) (HR=1.06; 95% CI=0.66–1.69; I 2 =75%; p<0.01) between surgical and imaging nodal assessment. Conclusions Imaging and surgical nodal assessment has comparable PFS and OS in patients with cervical cancer stage IB2–IVA. Trial Registration PROSPERO Identifier: CRD42020155486

Oncologic outcomes of surgical para-aortic lymph node staging in patients with advanced cervical carcinoma undergoing chemoradiation

“…Data comparing surgical to clinical staging in the cervical cancer population has been mixed with respect to feasibility, safety, and overall survival outcomes 7–11. For example, a retrospective study by Pomel et al evaluated 187 patients with locally advanced cervical cancer.…”

“…Overall, treatment modification following surgical staging occurred in 11 patients (18.3%). In a recent meta-analysis, Delara et al reported comparable oncologic outcomes between surgical and clinical staging 11. Authors included data from five studies, with a total of 1112 patients with FIGO 2009 stage IB2-IVA cervical cancer; 754 of them had surgical staging 11.…”

“…Nevertheless, para-aortic lymphadenectomy may be associated with post-operative complications that could potentially delay definitive radiotherapy administration, and with an increased incidence of lower extremity lymphedema 4–6. Evidence to guide treatment recommendations mainly derives from retrospective studies, and there is significant practice variation 7–11. Moreover, a recent randomized trial (UTERUS-11), did not demonstrate any difference in disease-free survival between clinical and surgical staging 12.…”

The impact of para-aortic lymph node irradiation on disease-free survival in patients with cervical cancer: A systematic review and meta-analysis

“…Most studies included in this review used CT or MRI for lymph node staging. However, these imaging modalities used to detect para-aortic lymph node metastases have limited sensitivity [38] , [39] , [40] . In addition, PET-CT was shown to have a low negative predictive value for detecting PAO-LNM [12] .…”

PET‐CT versus MRI in the diagnosis of lymph node metastasis of cervical cancer: A meta‐analysis

“…According to reports (Delara et al, 2020;Moro et al, 2020), the accuracy and SEN of MRI for detecting cervical cancer lymph node metastasis are between 76.22% and 100% 36.94% and 71.06%, respectively. Its main limitation is that it cannot distinguish between metastatic lymph nodes and nonmetastatic hyperplasias of similar size of lymph nodes (Devine et al, 2019).…”