Improved stratification of stage-specific survival for cervical uterine cancer by integrating FDG-PET/CT and MRI for lymph node staging in 2018 FIGO classification

Jorun Holm*, Oke Gerke, Mie Holm Vilstrup, Diana Spasojevic, Sara Elisabeth Sponholtz, Kirsten Jochumsen, Anders Thomassen, Malene Grubbe Hildebrandt, Pernille Tine Jensen


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Staging carcinoma of the uterine cervix (CCU) by FIGO-2018 suggests stage migration of FIGO-2009 stage I-III patients with lymph node metastasis into FIGO-2018 stage IIIC. We aimed to investigate the prognostic value of lymph node metastases identified by imaging.

We enrolled all patients with biopsy-verified CCU from 2007 to 2016 at Odense University Hospital, Denmark. FDG-PET/CT and MRI were performed before clinical examination in general anesthesia. Disease-specific mortality was compared between women with lymph node-positive and lymph node-negative imaging.

In total, 488 patients underwent clinical staging according to FIGO-2009. Lymph node-positive imaging was identified in 146 (30%) patients: 0/36 (0%) in stage IA, 22/195 (11%) in IBI, 14/30 (47%) in IB2, 70/164 (43%) in II and 40/63 (63%) in III. The 5-year cumulative incidence of death due to CCU lymph node-negative vs. lymph node-positive patients was 0.8% vs. 7.1% (p = 0.034) in stage IBI, 0% vs. 34.5% (p = 0.003) in stage IB2, 15.1% vs. 41.4% (p < 0.0001) in stage II, and 33.3% vs. 46.6% (p = 0.28) in stage III by FIGO-2009.

One of three women with FIGO-2009 stage I-III CCU had suspected lymph node metastasis on imaging and is upstaged to stage IIIC according to FIGO-2018. The cancer-specific mortality by CCU was significantly lower in the lymph node-negative women stages IBI-II, thus supporting stage migration due to suspected lymph node metastasis. However, the exact prognostic value within stage IIIC is challenged, and future revision of FIGO stages may include new sub-stages.
TidsskriftGynecologic Oncology
Udgave nummer2
Sider (fra-til)152-158
StatusUdgivet - nov. 2022

Bibliografisk note

•One-third of women with CCU were upstaged to stage IIIC by the FIGO-2018 staging system.

•Lymph node involvement by modern imaging is a significant prognostic factor in stages I-II but not in stage III.

•The prognostic properties within stage IIIC subgroups stratified by tumor size are variable.

•The sensitivity of lymph node imaging is low in early-stage CCU, and histological verification is warranted.


  • Cervical cancerFIGO-2018 stagingLymph node metastases