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