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Japanese Journal of Clinical Oncology Advance Access published online on May 10, 2005
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyi079
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© 2005 Foundation for Promotion of Cancer Research
Received March 15, 2005
Accepted March 17, 2005

Original Article

The Usefulness of MRI and PET Imaging for the Detection of Parametrial Involvement and Lymph Node Metastasis in Patients with Cervical Cancer

Won Park 1, Young Je Park 1, Seung Jae Huh 1*, Byoung Gie Kim 2, Duk Soo Bae 2, Jeho Lee 2, Bo Hyun Kim 3, Joon Young Choi 4, Yong Chan Ahn 5, and Do Hoon Lim 5

1 Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
2 Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
3 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
4 Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
5 Department of Radiation Oncology, Sungkyunkwan University School of Medicine, Seoul, Korea

* To whom correspondence should be addressed.
Seung Jae Huh, E-mail: sj5201.huh{at}samsung.com


  Abstract

Objective: The purpose of this study is to elucidate the usefulness of magnetic resonance imaging (MRI) and positron emission tomography (PET) for the detection of parametrial involvement and lymph node metastasis in patients with cervical cancer.

Methods: Thirty-six patients with cervical cancer were retrospectively enrolled. MRI and PET scans were performed for all patients within a week before radical surgery. The criterion for malignancy on MRI was >1 cm short axis diameter of the suspected lymph node. On PET, only fluorodeoxyglucose (FDG) uptake was significantly higher than the background and, if this FDG uptake showed on at least two consecutive axial slices, then the lesion was considered as a malignancy. We compared the extent of tumor on the surgical findings with the FIGO staging, MRI and PET scans.

Results: The accuracy of FIGO and MRI staging was 67 and 84.4%, respectively. The accuracy for detecting pelvic lymph node metastasis was better for PET than for MRI (78 versus 67%, respectively). All FDG uptake lymph nodes were confirmed as metastatic lymph nodes by pathological evaluation; this included five lymph nodes <1 cm in diameter.

Conclusion: MRI provides an improved evaluation of local tumor extension, but PET is more useful for the evaluation of pelvic lymph nodes than MRI; however, PET still misses microscopic disease. Further studies are necessary to evaluate the usefulness of PET/computed tomography (CT) for the accuracy of the disease extension and the cost-effectiveness of MRI, PET or PET/CT in patients with cervical cancer.

Keywords: cervical cancer; lymph node; MRI; PET.
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