Skip Navigation LinksHome > February 2013 - Volume 23 - Issue 2 > Isolated Mediastinal Lymph Node False Positivity of [18F]-Fl...
International Journal of Gynecological Cancer:
doi: 10.1097/IGC.0b013e31827e00cc
Cervical Cancer

Isolated Mediastinal Lymph Node False Positivity of [18F]-Fluorodeoxyglucose–Positron Emission Tomography/Computed Tomography in Patients With Cervical Cancer

Onal, Cem MD*; Oymak, Ezgi MD*; Findikcioglu, Alper MD; Reyhan, Mehmet MD

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Abstract

Objective: This study aimed to evaluate the degree of mediastinal involvement in patients with cervical cancer with isolated mediastinal [18F]-fluorodeoxyglucose–positron emission tomography (FDG-PET) positivity as verified by histopathologic examination.

Methods: Two hundred twenty-eight patients with newly diagnosed cervical cancer and who underwent FDG-PET imaging were analyzed. Twenty-nine patients (17%) had disseminated disease detected with PET/computed tomography (CT). Only 10 patients (4%) had increased FDG uptake in mediastinal lymph nodes alone. Of the 10 patients with mediastinal disease, 2 refused surgical mediastinal lymph node biopsy and did not receive any treatment. Patients with suspected paratracheal or subcarinal lymph node metastasis detected on PET/CT underwent mediastinoscopy, and those with hilar metastasis had video-assisted mediastinal lymphadenectomy. Treatment was delivered according to final staging based on histopathologic confirmation of mediastinal lymph node involvement.

Results: The mean (SD) maximum standardized uptake values for primary cervical tumor and mediastinal lymph nodes were 19.7 (10.3) and 7.5 (1.6), respectively. Of 8 patients who underwent mediastinal lymph node confirmation, 6 (75%) were tumor free, demonstrating granulomatous changes, and were treated curatively. No patients had residual or recurrent disease at the primary site, and all but 1 were alive without disease. Two patients with confirmed mediastinal lymph node metastasis were treated palliatively and died between 9 and 11 months after diagnosis.

Conclusions: Positron emission tomography/CT is an important tool for lymphatic staging and evaluation of distant metastases in cervical cancer. However, PET/CT should be interpreted cautiously for isolated mediastinal involvement; surgical evaluation is required for accurate staging and appropriate treatment decisions to achieve better outcomes.

Copyright © 2013 by IGCS and ESGO

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