![]() In addition, the common presence of FDG-avid sdLNs suggests that many FIGO stage IIIC patients actually have extra-abdominal disease. Pretreatment positron emission computed tomography (PET/CT) may reveal small supradiaphragmatic lymph node metastases (sdLNM) unreachable for sampling. International Federation of Gynecology and Obstetrics (FIGO) staging system requires histopathological verification of extra-abdominal metastases. Increasing evidence indicates that abnormal -fluoro-2-deoxy-D-glucose (FDG) accumulation in sdLNs is a common finding in advanced EOC. The need to extend cytoreductive surgery outside the abdominal cavity has recently been a focus of interest. The vast majority of EOC is diagnosed at an advanced stage and optimal removal of intraabdominal tumor bulk forms a major prognostic factor for survival. Due to their distribution to multiple regions, the benefit of removal of reachable sdLNS seems unlikely. The behavior of metabolically active sdLNs during chemotherapy supports their metastatic nature. Persistent post-treatment metabolic activity did not predict earlier disease relapse ( p = 0.59). In 50% of the responders the same sdLNs reactivated when recurrence occurred. The size and SUVmax values did not predict treatment outcome. The sdLNs became inactive during primary chemotherapy more often in the RECIST responders compared to the non-responders (HR 1.46 (95%CI: 1.09–1.96), p = 0.002). Only 6/41 patients had FDG-avid sdLNs in a single surgically approachable site. Only a minority (22/136) of the sdLNs were enlarged in size, but their histopathologic confirmation by biopsy was not possible. In pretreatment scan, 76% (31/41) of patients had FDG-avid sdLNs in multiple anatomical sites. ![]() Resultsįorty-one patients with 127 PET/CT scans were systematically evaluated. The behavior of sdLNs during chemotherapy were compared in treatment responders and non-responders. The patients´ overall response to primary treatment was defined with RECIST criteria. In each patient, 2 most active LNs in 5 different supradiaphramatic regions were evaluated and the size and changes in FDG uptake (SUVmax) were recorded. MethodsĮOC patients with PET positive sdLNs at diagnosis were prospectively followed with PET/CT after primary chemotherapy and at the first recurrence. Their clinical significance and behavior during treatment has not been established. Epithelial ovarian cancer (EOC) typically spreads intra-abdominally, but preoperative evaluation with FDG PET/CT often reveals metabolically active supradiaphragmatic lymph nodes (sdLNs). ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |