Nav: Home

SPECT-MRI fusion minimizes surgery for diagnosis of early-stage cervical cancer patients

April 14, 2016

Reston, VA - A recent study reported in the April issue of The Journal of Nuclear Medicine found that cervical cancer patients without enlarged lymph nodes could benefit from SPECT-MRI imaging of their sentinel lymph nodes (SLNs) to assess whether metastases are present.

Cervical cancer is the fourth most common cancer in women worldwide, with more than 500,000 new cases globally each year. According to a 2014 University of Maryland study, cervical cancer affects 18.6 women per 100,000 in the United States. Early diagnosis is critical. Although surgical removal and examination of the sentinel lymph nodes remains the most accurate way to determine whether the cancer has spread to the lymph nodes, SPECT-MRI imaging may reduce false negative MRI findings in early-stage patients and potentially save some from invasive diagnostic procedures.

Researchers at the University Medical Center Utrecht, Netherlands, used Tc-99m-nanocolloid SPECT-MRI fusion for the assessment of SLNs (for size and absence of sharp demarcation) in patients with early-stage cervical cancer.

Jacob P. Hoogendam, MD, the corresponding author of the study, notes, "An interesting aspect of this research, and the field in general, is that we are taking more and more steps toward combined technology to minimize invasive diagnostics in patients with cervical cancer." He adds, "With these methods we aim to reduce morbidity via more tailored and informed selections between radical hysterectomy and chemo/radiation for each patient, instead of solely stage-based treatment selections."

Between March 2011 and February 2015, the research team evaluated stage IA1-IIB1 cervical cancer patients who presented at the center. Patients with enlarged lymph nodes on MRI were excluded. The remaining patients underwent an SLN mapping procedure with preoperative Tc-99m-nanocolloid SPECT-CT. By creating fused datasets of the SPECT and MRI, SLNs could be identified on MRI with accurate correlation to the histological result of each individual SLN. An experienced radiologist, with no knowledge of the histology, retrospectively reviewed all fused SPECT-MRIs and scored morphologic SLN parameters on a standardized case report form. Logistic regression and receiver operating curves (ROC) were used to model the parameters against the SLN status. In 75 cases, 136 SLNs were eligible for analysis, of which 13 (9.6 percent) contained metastases (eight cases).

Hoogendam points out the value of evaluating patients with stage 1 or 2 cervical cancer for the non-invasive SPECT-MRI diagnostic procedure: "We need to be aware that a dichotomous lymph node cut-off on MRI, typically a 10mm short axis diameter to determine whether it is suspicious or not, is relatively crude and certainly does not fit all patients," he explains. "Our study investigated whether a more individualized, imaging-based assessment is possible for the small metastases that are currently missed on imaging (i.e., false negative on MRI)."

He elaborates, "The novelty of our study is the focused review of fewer than five sentinel nodes, instead of indiscriminately reviewing the entire pelvic lymphatic chain (up to 100 nodes per patient). Less is more." Hoogendam adds, "This new imaging approach is a first step, and we hope it sparks further research."

He also argues for an interdisciplinary approach to both clinical practice and research, stating, "This sentinel node focus requires a combination of preoperative nuclear medicine imaging (SPECT), radiology (MRI), and the gynecological oncology department (intraoperative sentinel node procedure). We should not be islands within a hospital; better interdisciplinary cooperation can synergistically lead to new insights, more relevant research questions, and better patient care."
Authors of the article "99mTc-nanocolloid SPECT-MRI fusion for the selective assessment of non-enlarged sentinel lymph nodes in patients with early stage cervical cancer" include Jacob P. Hoogendam, Ronald P. Zweemer, Monique G.G. Hobbelink, Maurice A.A.J. van den Bosch, René H.M. Verheijen, and Wouter B. Veldhuis of University Medical Center Utrecht, Netherlands.

Please visit the SNMMI Media Center to view the PDF of the study, including images, and more information about molecular imaging and personalized medicine. To schedule an interview with the researchers, please contact Laurie Callahan at (703) 652-6773 or Current and past issues of The Journal of Nuclear Medicine can be found online at

The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international scientific and medical organization dedicated to raising public awareness about nuclear medicine and molecular imaging, a vital element of today's medical practice that adds an additional dimension to diagnosis, changing the way common and devastating diseases are understood and treated and helping provide patients with the best health care possible.

SNMMI's more than 17,000 members set the standard for molecular imaging and nuclear medicine practice by creating guidelines, sharing information through journals and meetings and leading advocacy on key issues that affect molecular imaging and therapy research and practice. For more information, visit

Society of Nuclear Medicine

Related Cancer Articles:

Radiotherapy for invasive breast cancer increases the risk of second primary lung cancer
East Asian female breast cancer patients receiving radiotherapy have a higher risk of developing second primary lung cancer.
Cancer genomics continued: Triple negative breast cancer and cancer immunotherapy
Continuing PLOS Medicine's special issue on cancer genomics, Christos Hatzis of Yale University, New Haven, Conn., USA and colleagues describe a new subtype of triple negative breast cancer that may be more amenable to treatment than other cases of this difficult-to-treat disease.
Metabolite that promotes cancer cell transformation and colorectal cancer spread identified
Osaka University researchers revealed that the metabolite D-2-hydroxyglurate (D-2HG) promotes epithelial-mesenchymal transition of colorectal cancer cells, leading them to develop features of lower adherence to neighboring cells, increased invasiveness, and greater likelihood of metastatic spread.
UH Cancer Center researcher finds new driver of an aggressive form of brain cancer
University of Hawai'i Cancer Center researchers have identified an essential driver of tumor cell invasion in glioblastoma, the most aggressive form of brain cancer that can occur at any age.
UH Cancer Center researchers develop algorithm to find precise cancer treatments
University of Hawai'i Cancer Center researchers developed a computational algorithm to analyze 'Big Data' obtained from tumor samples to better understand and treat cancer.
New analytical technology to quantify anti-cancer drugs inside cancer cells
University of Oklahoma researchers will apply a new analytical technology that could ultimately provide a powerful tool for improved treatment of cancer patients in Oklahoma and beyond.
Radiotherapy for lung cancer patients is linked to increased risk of non-cancer deaths
Researchers have found that treating patients who have early stage non-small cell lung cancer with a type of radiotherapy called stereotactic body radiation therapy is associated with a small but increased risk of death from causes other than cancer.
Cancer expert says public health and prevention measures are key to defeating cancer
Is investment in research to develop new treatments the best approach to controlling cancer?
UI Cancer Center, Governors State to address cancer disparities in south suburbs
The University of Illinois Cancer Center and Governors State University have received a joint four-year, $1.5 million grant from the National Cancer Institute to help both institutions conduct community-based research to reduce cancer-related health disparities in Chicago's south suburbs.
Leading cancer research organizations to host international cancer immunotherapy conference
The Cancer Research Institute, the Association for Cancer Immunotherapy, the European Academy of Tumor Immunology, and the American Association for Cancer Research will join forces to sponsor the first International Cancer Immunotherapy Conference at the Sheraton New York Times Square Hotel in New York, Sept.

Related Cancer Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Do animals grieve? Do they have language or consciousness? For a long time, scientists resisted the urge to look for human qualities in animals. This hour, TED speakers explore how that is changing. Guests include biological anthropologist Barbara King, dolphin researcher Denise Herzing, primatologist Frans de Waal, and ecologist Carl Safina.
Now Playing: Science for the People

#SB2 2019 Science Birthday Minisode: Mary Golda Ross
Our second annual Science Birthday is here, and this year we celebrate the wonderful Mary Golda Ross, born 9 August 1908. She died in 2008 at age 99, but left a lasting mark on the science of rocketry and space exploration as an early woman in engineering, and one of the first Native Americans in engineering. Join Rachelle and Bethany for this very special birthday minisode celebrating Mary and her achievements. Thanks to our Patreons who make this show possible! Read more about Mary G. Ross: Interview with Mary Ross on Lash Publications International, by Laurel Sheppard Meet Mary Golda...