Evaluation of Para-Aortic Lymph Node Involvement and Its Correlation with Different Pelvic Factors in Carcinoma Cervix Assessed by PET-CT

Sulagna  Mohanty; Biswa Ranjan  Routroy; Tapas Kumar  Dash

Authors

Sulagna Mohanty Assistant Professor, Department of Radiation Oncology, AHPGIC, Cuttack, Odisha
Biswa Ranjan Routroy Associate Professor, Department of Radiation Oncology, VIMSAR Burla, Odisha
Tapas Kumar Dash Assistant Professor, Department of Radiation Oncology, Acharya Harihar Postgraduate Institute of Cancer

Abstract

Background: In India, cervical cancer continues to be a major cause of cancer-related death for women, especially in the eastern state of Odisha. A crucial prognostic marker, the condition of the para-aortic lymph nodes (PALN) can dramatically change the staging (FIGO 2021) and treatment options from locoregional radiation to systemic therapy or extended-field radiotherapy (EFRT). The gold standard for nodal staging is Positron Emission Tomography-Computed Tomography (PET-CT), yet there is little information linking particular pelvic characteristics to PALN involvement in the eastern Indian population.

Objectives: The purpose of this study is to assess the prevalence of PALN involvement in locally advanced cervical cancer (LACC) using 18F-FDG PET-CT and to ascertain the relationship between PALN metastasis and other pelvic variables, such as tumor size, parametrial invasion, and pelvic lymph node (PLN) features.

Methods: At the Acharya Harihar Post Graduate Institute of Cancer (AHPGIC), Cuttack, a combined retrospective and prospective study was carried out between January 2021 and December 2023. Pre-treatment whole-body 18F-FDG PET-CT was performed on 165 histopathologically confirmed cases of cervical cancer (FIGO stages IB–IVA). Chi-square and logistic regression tests were used in statistical analysis to evaluate correlations.

Results: 52 years old was the median age. 18.2% (n=30) of individuals had PALN involvement (Stage IIIC2). PALN positive was found to be statistically significantly correlated with multiple () pelvic nodes (), parametrial invasion (), and pelvic
lymph nodes . Based on pelvic nodal burden, PET-CT had a sensitivity of 86.6% and a specificity of 94.1% for predicting PALN involvement.

Conclusion: PET-CT is a crucial technique for non-invasive cervical cancer staging. Parametric invasion and a high pelvic nodal load are strong markers of para-aortic metastases. In resource-constrained settings like in Odisha, identifying these high-risk pelvic characteristics can assist guide the wise use of EFRT, potentially improving survival results.

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