KEY TAKEAWAYS
- The study aimed to assess the diagnostic performance of ultrasonography in pre-operative assessment of lymph nodes in pts with CC.
- Ultrasonography if performed by experienced sonographers can be adequate for pre-operative CC lymph node assessment.
Filip Fruhauf and the team aimed to assess the diagnostic performance of ultrasonography in pre-operative assessment of lymph nodes in patients (pts) with cervical cancer (CC), conduct a comparative analysis of the outcomes for pelvic and para-aortic regions, and detect the macro and micro-metastases separately.
Researchers conducted a retrospective study that included pts with pathologically confirmed CC. Additional patient inclusion criteria included- surgical lymph node staging, at least in the pelvic region-sentinel lymph node biopsy or systematic pelvic lymphadenectomy or debulking. The final pathological examination was considered as the reference standard during the study.
Results indicated that from 2009 to 2019, 390 pts meeting the inclusion criteria were enrolled in the study. Pelvic nodes were confirmed by the presence of having macrometastases (≥2 mm) and 21 (5.4%) with micrometastases (≥0.2 mm and <2 mm) in 75 pts: 54 (13.8%).
Ultrasonography showcased a sensitivity of 72.2% and specificity of 94.0%, with an area under the curve (AUC) of 0.831 for detecting pelvic macrometastases. For detecting both macrometastases and micrometastases (pN1), sensitivity was 53.3%, specificity was 94.0%, and the AUC was 0.737. However, ultrasonography had low sensitivity (19.2%) and modest specificity (85.2%) with an AUC of 0.522 for detecting pelvic micrometastases. Body mass index did not significantly impact diagnostic accuracy.
Among 71 pts who underwent para-aortic lymphadenectomy, 16 had confirmed macrometastases in para-aortic nodes. Ultrasonography demonstrated a sensitivity of 56.3%, a specificity of 98.2%, and an AUC of 0.772 for identifying para-aortic node macrometastases.
The study concluded that ultrasonography if performed by an expert sonographer could be regarded as a potentially robust diagnostic tool for pre-operative assessment of lymph nodes in pts with CC. Along with similar diagnostic precision levels in detecting the pelvic macrometastases as reported for other imaging methods (18F-fluorodeoxyglucose positron emission tomography/CT or diffusion-weighted imaging/MRI).
Further, ultrasonography demonstrated low sensitivity for small-volume macro and micro-metastases. Precision in the para-aortic evaluation was found similar to pelvic nodes, underscoring its importance in diagnostic procedures.
This work was supported by a grant from the Czech Health Research Council, Ministry of Health (AZV ČR NU21-03-00461).
Source: https://pubmed.ncbi.nlm.nih.gov/38950926/
Fruhauf F, Cibula D, Kocian R, et al. (2024). “Diagnostic performance of ultrasonography in pre-operative assessment of lymph nodes in patients with cervical cancer.” Int J Gynecol Cancer. 2024 Jul 1;34(7):985-992. doi: 10.1136/ijgc-2024-005341. PMID: 38950926.
