Surgical‐pathologic risk factors of pelvic lymph node metastasis in stage Ib1‐IIb cervical cancer

Abstract

High LNM risk is expected in tumors of IIa stage or higher and in moderately differentiated tumors. Skip metastasis and common iliac LNM are relatively common and therefore should not be neglected. Our results suggest that standardized and complete pelvic lymph node dissection under surgery is an important measure to ensure a therapeutic effect.

A risk‐based approach to identifying oligometastatic disease on imaging

“…It has long been known that histological type and grade of a tumour is indicative of metastatic risk. 18,19 A breast cancer series of >2,000 patients from 8 German centres showed that metastases at presentation were more commonly associated with grade 3 lobular histology and a Luminal B phenotype (HER2 positive). 20 In primary soft-tissue sarcoma, where histological type varies widely, tumour grade has been shown to be independent of histological subtype for predicting metastatic relapse.…”

“…33 High SUV as an independent biomarker of prognosis has been borne out in lung cancer (meta-analysis of 21 lung cancer studies had a combined hazard ratio of 2.08), 34 in breast cancer (hazard ratio 2.39) 35 and in soft-tissue sarcoma (hazard ratio 3.75), 36 where it has been related to mitotic count. 37 In renal cell cancer, the apparent diffusion coefficient (ADC) 38 derived from diffusion-weighted MRI and SUV max from 18 FDG-PET have been shown to be statistically significant independent risk factors for high histological grade and hence of metastatic risk. 39 Heterogeneity of morphological and functional imaging features is proving of interest in predicting metastatic risk.…”

“…39 Heterogeneity of morphological and functional imaging features is proving of interest in predicting metastatic risk. Although the data from 18 FDG PET remains controversial 40,41 entropy measures from histogram analyses of MRI based tumour ADC can predict positive nodal status in rectal cancers 42 and in gastric cancers, while in soft-tissue sarcomas, first order statistics from ADC, which relate to signal variability and to entropy and dissimilarity, were higher in high grade tumours. 43 Finally, the initial response of the primary tumour to a given chemotherapy is also a powerful prognostic indicator [44][45][46][47] for subsequent development of metastases.…”

“…Sensitivity, specificity and accuracy against a surgical gold standard for lymph node detection in a multicentre study for 68 Ga-PSMA PET in the primary setting were 53%, 86% and 76% but improved with higher surgical sampling, increasing to 67%, 88% and 81% in a subgroup with of patients with ≥15 lymph nodes removed. 58 Imaging data for these newer agents has been validated and shown to reflect target expression: a small but intensive study of targeted agents such as 18 F-DHT and 18 F-ES (Estradiol) showed that semi-quantitative androgen or oestrogen receptor expression on immunohistochemistry and 18 F-DHT or 18 F-ES uptake respectively on PET was correlated. Moreover, using optimal cut-offs (SUV max of 1.94 for 18 FDHT-PET and 1.54 for 18 FES-PET) sensitivities of 91% and 100% and specificities of 100% and 100% respectively were achieved.…”

“…58 Imaging data for these newer agents has been validated and shown to reflect target expression: a small but intensive study of targeted agents such as 18 F-DHT and 18 F-ES (Estradiol) showed that semi-quantitative androgen or oestrogen receptor expression on immunohistochemistry and 18 F-DHT or 18 F-ES uptake respectively on PET was correlated. Moreover, using optimal cut-offs (SUV max of 1.94 for 18 FDHT-PET and 1.54 for 18 FES-PET) sensitivities of 91% and 100% and specificities of 100% and 100% respectively were achieved. 59 Whole-body MRI has the advantage of combining morphological data (T1 and T2-W imaging) with functional information (diffusion-weighted and dynamic contrast-enhanced imaging) thus simultaneously exploiting multiple contrast mechanisms to image and detect the presence of disease.…”