| Value of PET-CT in avoiding multimodality therapy in operable cervical cancer. | |
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MedLine Citation:
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PMID: 20683414 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Posttreatment morbidity of multimodality therapy is substantially higher than either radical surgery or chemoradiation alone. Preoperative prediction of positive nodes limits optimal selection of the primary treatment modality. Computed tomography (CT) and magnetic resonance imaging have been tried for nodal assessment with modest results. Positron emission tomography (PET) combined with CT seems to be promising in this regard. This clinicopathologic study assesses the value of PET-CT in predicting nodal metastasis and avoiding multimodality therapy. MATERIALS AND METHODS: Eighty patients with clinically operable cervical cancer underwent PET-CT during the preoperative evaluation followed by radical hysterectomy. Adjuvant chemoradiation was administered when indicated by histopathologic findings. The histopathologic finding of the pelvic nodes was correlated with the PET-CT findings for nodal metastasis. The chi2 test was used as the test of significance in the statistical analysis. OBSERVATIONS: Of 62 patients found PET-CT negative for nodal disease, 52 were true negative, whereas 10 were false negative on histopathologic examination. On the other hand, 14 of 18 patients found PET-CT positive for nodal disease were true positives. Specificity, sensitivity, positive predictive value, and negative predictive value of PET-CT in nodal assessment were found to be 92.8, 58.33, 77.7, and 83.8, respectively. Twenty-four patients (30%) with pelvic nodes positive for disease on histopathologic examination were administered adjuvant chemoradiation. Had we operated only on those patients who were PET-CT negative for nodal disease, 10 of 62 patients would have required adjuvant chemoradiation for positive nodes. Eighteen patients found PET-CT positive for nodal disease would be treated with primary chemoradiation. Inclusion of PET-CT in the decision-making process for primary surgery versus primary chemoradiation would allow 87.5% patients to receive a single modality of treatment (65%, only surgery; 22.5%, only chemoradiation) and the proportion of patients requiring multimodality treatment would reduce significantly from 30% to 12.5% (P < 0.01). CONCLUSION: Positron emission tomography combined with CT in the evaluation of operable cervical cancer can help in the optimal selection of patients for surgery such that multimodality treatment with its attendant increase in morbidity is avoided. |
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Authors:
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Bhupesh K Goyal; Harkirat Singh; Krishan Kapur; Bhupinder S Duggal; Mattakarottu J Jacob |
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Publication Detail:
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Type: Journal Article; Validation Studies |
Journal Detail:
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Title: International journal of gynecological cancer : official journal of the International Gynecological Cancer Society Volume: 20 ISSN: 1525-1438 ISO Abbreviation: Int. J. Gynecol. Cancer Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-08-04 Completed Date: 2010-10-15 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9111626 Medline TA: Int J Gynecol Cancer Country: United States |
Other Details:
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Languages: eng Pagination: 1041-5 Citation Subset: IM |
Affiliation:
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Department of Obstetrics and Gynecology, Army Hospital (Research & Referral), New Delhi, India. bkgnona@gmail.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Biopsy, Needle Chemotherapy, Adjuvant Chi-Square Distribution Cohort Studies Combined Modality Therapy Female Fluorodeoxyglucose F18 / diagnostic use* Humans Hysterectomy / methods Immunohistochemistry Lymph Nodes / pathology* Middle Aged Neoplasm Staging Positron-Emission Tomography / methods* Predictive Value of Tests Preoperative Care / methods Radiotherapy, Adjuvant Sensitivity and Specificity Tomography, X-Ray Computed Uterine Cervical Neoplasms / pathology, radionuclide imaging*, surgery*, therapy |
| Chemical | |
Reg. No./Substance:
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63503-12-8/Fluorodeoxyglucose F18 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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