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Am J Clin Oncol. 2010 Feb;33(1):89-93. doi: 10.1097/COC.0b013e31819fdfae.

A prospective trial comparing lymphangiogram, cross-sectional imaging, and positron emission tomography scan in the detection of lymph node metastasis in locally advanced cervical cancer.

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Department of Radiation Oncology, The Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA.



This study prospectively evaluated the use of lymphangiogram, computed tomography/magnetic resonance imaging, and positron emission tomography (PET) imaging of lymph node metastasis in patients receiving definitive chemoradiotherapy for cervical cancer.


Twenty patients underwent lymphangiogram, computed tomography/magnetic resonance imaging, and PET. There was no histologic verification of metastasis. Four lymph node regions, including the internal, external, and common iliacs, and para-aortic, were scored as positive or negative for metastasis. Agreement between imaging was analyzed using multirater kappa and disease-free survival utilizing Kaplan Meier survival curves and log-rank test.


Agreement between imaging was most consistent in the common iliacs (P < 0.001) and least in the para-aortic region (P = 0.41). Disease-free survival (DFS) at one year was statistically associated with positive PET imaging (25%) versus negative PET imaging (86%) (P = 0.033) in the common iliac lymph node region. No other single lymph node region in any modality was statistically associated with DFS. One-year DFS in patients with any positive areas on PET imaging was 50% compared with 90% in patients with negative PET imaging (P = 0.02). Seven patients were noted to have no metastasis in any region by all 3 of the imaging modalities; the 1-year DFS in these 7 patients was 100% compared with 59% in the 13 patients with any positive nodal area (P = 0.05).


Positive lymphadenopathy on PET imaging was associated with reduced DFS.

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