Occult supraclavicular lymph node metastasis identified by FDG-PET in patients with carcinoma of the uterine cervix

Abstract

Purpose The objective was to evaluate the frequency and prognostic significance of occult supraclavicular lymph node metastases identified by 2-[ 18F]fluoro-2-deoxy- d-glucose–positron emission tomography (FDG-PET) in patients with cervical carcinoma. Patients and methods Between March 1998 and January 2002, 186 patients with a new diagnosis of cervical cancer underwent whole-body FDG-PET before therapy. Fourteen patients had abnormal FDG uptake in left supraclavicular lymph nodes without palpable disease. All 14 patients underwent sonographically guided fine-needle aspiration of the left supraclavicular lymph nodes. One patient refused therapy, 6 were treated with palliative intent, and 7 received definitive irradiation and concurrent chemotherapy. Survival was calculated by the Kaplan–Meier method. Results The overall frequency of FDG-positive left supraclavicular lymph nodes was 8% (14/186). Metastasis was pathologically confirmed in all 14 patients. Therefore, the positive predictive value of abnormal FDG uptake in left supraclavicular lymph nodes was 100%. Nineteen percent of all patients (35/186) had abnormal FDG uptake in para-aortic lymph nodes. The frequency of positive FDG uptake in the left supraclavicular lymph nodes was 40% (14/35) in those with para-aortic lymph node uptake and 15% in those with stage IIIb disease. The median overall survival was 7.5 months. At last follow-up, 11 patients were dead and 3 were alive with disease. All patients developed metastatic disease, most commonly to bone and lung. Conclusion The positive predictive value of abnormal FDG uptake in left supraclavicular lymph nodes was 100%. Prognosis for these patients was dismal despite aggressive therapy.