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Accuracy of two dimensional ultrasonography in detecting lymph node metastasis in cases of uterine and cervical malignancies seen in a tertiary hospital: A five year restropective study

Kathlynn Ann R. dela Llana, MD and Kareen N. Reforma, MD, FPOGS
Department of Obstetrics and Gnecology, Philippine General Hospital, University of the Philippines-Manila

Objective: This study aims to determine the accuracy of two dimensional ultrasound in detecting lymph node metastasis in uterine and cervical (stage IA2-IIA) malignancies.

Materials and Methods: This is a five-year retrospective, cross sectional study conducted for 6 months among uterine and cervical malignancy patients who underwent bilateral pelvic lymph node dissection and para-aortic lymph node sampling with ultrasound performed within two months prior to surgery in a tertiary hospital. Ultrasound findings were compared with histopathologic results as gold standard.

Results: The study included 319 patients, 267 uterine and 52 cervical malignancies. Uterine cancer (pelvic-7.1% and para-aortic-2.6%) and cervical cancer (pelvic-1.95%) nodal involvement showed majority having round shape. Mean pelvic nodal size was 1.75 x 0.93cm-uterine, 1.83 x 0.93cm-cervical and para-aortic 3.3x2.0cm-uterine. The study revealed accuracy, sensitivity, specificity, PPV and NPV of 91.5%, 29.4%, 96.4%, 25.0% and 96.0% respectively for pelvic node metastasis and 95.6%, 11.1%, 98.1%, 14.3% and 97.4% respectively for para-arotic involvement. Ultrasound accuracy in detecting pelvic node extension was 98.1%-cervical and 90.3%-uterine (sensitivity-50% vs 26.7%; specificity-100% vs 94.1%; PPV-100% vs 21.1% and NPV-100% vs 95.6%). Para-aortic nodal metastasis detection among cervical and uterine cancer patients showed the following: accuracy (98.1% vs 95.1%), specificity (100% vs 97.7%), and NPV (98.1% vs 97.3%).

Conclusion: Two-dimensional ultrasound is reliable in ruling in the presence of pelvic and para-aortic lymph node metastasis among patients with uterine and cervical malignancies. However, its low sensitivity of detection makes it less dependable in ruling out nodal involvement. Larger size and round shape of lymph nodes represent nodal meatastasis.