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Mirror-image lymph node in FDG PET/CT and SPECT/CT for sentinel node detection.

Beatriz Domenech¹, Pilar Paredes, Sebastià Rubí

¹From the Departments of *Nuclear Medicine, and †Gynecology and Obstetrics, Hospital Clinic de Barcelona, Barcelona, Spain.

Clinical Nuclear Medicine

|January 25, 2014

Summary

FDG PET/CT identified a malignant left iliac node in cervical cancer, despite negative sentinel lymph node biopsy. This highlights FDG PET/CT

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Area of Science:

Oncology
Nuclear Medicine
Surgical Pathology

Background:

Cervical cancer staging relies on accurate lymph node assessment.
Sentinel lymph node (SLN) biopsy is a standard staging procedure.
FDG PET/CT is an emerging imaging modality in oncology.

Observation:

A patient with presumed stage IB1 cervical squamous cell carcinoma presented with a hypermetabolic left iliac node on FDG PET/CT.
Lymphoscintigraphy and SPECT/CT indicated right pelvic lymphatic drainage.
Intraoperative SLN biopsy was negative for malignancy.

Findings:

The hypermetabolic left iliac node revealed macrometastasis upon pathological assessment.
Tumor invasion can cause lymphatic blockage, leading to false-negative SLN results.
FDG PET/CT demonstrated a hypermetabolic lesion not detected by SLN biopsy.

Implications:

This case underscores the potential for lymphatic blockage in cervical cancer.
FDG PET/CT can identify metastatic lymph nodes missed by SLN biopsy.
FDG PET/CT offers valuable preoperative information, complementing surgical staging.