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Gynecol Oncol. 2013 Dec;131(3):701-7. doi: 10.1016/j.ygyno.2013.10.014. Epub 2013 Oct 19.

A novel diagnostic criterion for lymph node metastasis in cervical cancer using multi-detector computed tomography.

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Department of Gynecology and Obstetrics, Kyoto University, Graduate School of Medicine, Japan.



The sensitivity of the current 10mm cut-off diameter that is used to diagnose lymph node (LN) metastasis is too low. This is the first study to develop a new criterion to diagnose LN metastasis in a region-by-region manner using multi-detector computed tomography (MDCT).


1) The short-axis diameter of the LNs in MDCT images from 1-mm slices obtained immediately prior to surgery was compared with the pathological diagnosis in 78 uterine cervical cancer patients undergoing primary surgery. For the region-by-region analysis, we divided para-aortic and pelvic spaces into 13 regions. 2) In 28 cases in which patients received neoadjuvant chemotherapy (NAC) followed by surgery, we compared MDCT images before and after NAC.


1) The optimal cut-off in the region-by-region analysis was 5mm, yielding 71% sensitivity and 79% specificity. 2) NAC significantly decreased LN size (p<0.0001). NAC decreased the number of swollen LN regions (>5mm) from 51% (81/158) to 26% (41/158).


The new criterion developed using MDCT could be effective for accurately assessing LN status. It also facilitates the assessment of NAC efficacy regarding the eradication of LN metastases.


Cervical cancer; Lymph node metastasis; Multi-detector computed tomography (MDCT); Neoadjuvant chemotherapy (NAC)

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