99mTc-nanocolloid SPECT-MRI fusion for the selective assessment of non-enlarged sentinel lymph nodes in patients with early stage cervical cancer

We aimed to explore the accuracy of ^99mTc SPECT–MRI fusion for the selective assessment of non-enlarged sentinel lymph nodes (SLNs) for diagnosing metastases in early stage cervical cancer patients. Methods: We consecutively included stage IA1 – IIB1 cervical cancer patients who presented to our tertiary referral center between March 2011 and February 2015. Patients with enlarged lymph nodes (short axis ≥10mm) on MRI were excluded. Patients underwent a SLN procedure with preoperative ^99mTc-nanocolloid SPECT–CT based SLN mapping. By creating fused datasets of the SPECT and MRI, SLNs could be identified on MRI with accurate correlation to the histological result of each individual SLN. An experienced radiologist, blinded to histology, retrospectively reviewed all fused SPECT–MRI's and scored morphologic SLN parameters on a standardized case report form. Logistic regression and receiver operating curves (ROC) were used to model the parameters against the SLN status. Results: In 75 cases, 136 SLNs were eligible for analysis of which 13 (9.6%) contained metastases (8 cases). Three parameters, short axis diameter, long axis diameter and absence of sharp demarcation significantly predicted metastatic invasion of non-enlarged SLNs with a quality adjusted odds ratios of 1.42 (95%CI: 1.01 – 1.99), 1.28 (95%CI: 1.03 – 1.57) and 7.55 (95%CI: 1.09 – 52.28) respectively. The area under the curve of the ROC combining these parameters was 0.749 (95%CI: 0.569 – 0.930). Heterogeneous gadolinium enhancement, cortical thickness, round-shape or SLN-size compared to the nearest non-SLN, showed no association with metastases (p 0.055 – 0.795). Conclusion: In cervical cancer patients without enlarged lymph nodes, selective evaluation of only the SLNs – for size and absence of sharp demarcation – can be used to noninvasively assess the presence of metastases.

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