A novel diagnostic criterion for lymph node metastasis in cervical cancer using multi-detector computed tomography

•Using multi-detector CT, we identified a novel criterion to diagnose lymph node metastasis in a region-by-region manner.•The criterion, 5 mm in a short-axis diameter, helps us precisely assess the lymph node status of cervical cancer patients.•This new criterion should help us develop individualized treatments for cervical cancer patients.

ObjectivesThe sensitivity of the current 10 mm cut-off diameter that is used to diagnose lymph node (LN) metastasis is too low. This is the first study to develop a new criterion to diagnose LN metastasis in a region-by-region manner using multi-detector computed tomography (MDCT).Methods1) The short-axis diameter of the LNs in MDCT images from 1-mm slices obtained immediately prior to surgery was compared with the pathological diagnosis in 78 uterine cervical cancer patients undergoing primary surgery. For the region-by-region analysis, we divided para-aortic and pelvic spaces into 13 regions. 2) In 28 cases in which patients received neoadjuvant chemotherapy (NAC) followed by surgery, we compared MDCT images before and after NAC.Results1) The optimal cut-off in the region-by-region analysis was 5 mm, yielding 71% sensitivity and 79% specificity. 2) NAC significantly decreased LN size (p < 0.0001). NAC decreased the number of swollen LN regions (> 5 mm) from 51% (81/158) to 26% (41/158).ConclusionsThe new criterion developed using MDCT could be effective for accurately assessing LN status. It also facilitates the assessment of NAC efficacy regarding the eradication of LN metastases.