BACKGROUND: The objective of the current study was to determine the accuracy of magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) for detecting lymph node metastases in patients with uterine cervical carcinoma compared with thin‐section histopathologic results from systemic lymphadenectomy.METHODS: Twenty‐two patients with International Federation of Obstetrics and Gynecology (FIGO) Stage IB–IVA cervical carcinoma who underwent both MRI and PET/CT before lymphadenectomy were included in this study. Lymphadenectomy involved removing all visible lymph nodes in the surgical fields. To enable region‐specific comparisons, paraaortic and pelvic lymph nodes were divided into seven regions: the paraaortic area, both common iliac areas, both external iliac areas, and both internal iliac/obturator areas. Histopathologic evaluation of lymph nodes was the diagnostic standard. Chi‐square analysis was used to compare the accuracy of MRI and PET/CT for the detection of metastatic lymph nodes. A P value ≤ 0.05 was considered statistically significant.RESULTS: With MRI, the sensitivity, specificity, and accuracy rates for detecting metastatic lymph nodes in each lymph node group were 30.3% (10 of 33 lymph node groups), 92.6% (112 of 121 lymph node groups), and 72.7% (122 of 154 lymph node groups), respectively; with PET/CT, those rates were 57.6% (19 of 33 lymph node groups), 92.6% (112 of 121 lymph node groups), and 85.1% (131 of 154 lymph node groups), respectively. Statistical analysis showed that PET/CT was more sensitive than MRI (P = 0.026) but that there were no statistical differences noted with regard to specificity (P = 1.000) or accuracy (P = 0.180). Power analysis demonstrated that a sample size of 685 lymph node groups (98 patients) would be necessary to demonstrate that PET/CT was more accurate than MRI (α = 0.05; β = 0.80).CONCLUSIONS: PET/CT was more sensitive than MRI for detecting lymph node metastases in patients with uterine cervical carcinoma. Cancer 2006. © 2006 American Cancer Society.

Cervical cancer remains one of the most prevalent cancers among females worldwide. Therefore, it is important to discover new biomarkers for early diagnosis of cervical intraepithelial neoplasia (CIN) and cervical cancer, preferably non-invasive ones. In the present study, we aimed to identify unique metabolic signatures for CINs and cervical cancers using global and targeted metabolomic profiling. Plasma samples (69 normal, 55 CIN1, 42 CIN2/3, and 60 cervical cancer) were examined by ultra-performance liquid chromatography-quadrupole-time-of-flight mass spectrometry (UPLC-QTOF-MS) coupled with multivariate statistical analysis. Metabolic pathways were analyzed using the integrated web-based tool MetaboAnalyst. A multivariate logistic regression analysis was conducted to evaluate the combined association of metabolites and human papillomavirus (HPV) status with the risk of cervical carcinogenesis. A total of 28 metabolites exhibiting discriminating levels among normal, CIN, and cervical cancer patients (Kruskal–Wallis test p < 0.05) were identified in the global profiling analysis. The pathway analysis showed significantly altered alanine, aspartate, and glutamate metabolic pathways (FDR p-value < 0.05) in both the discovery and validation phases. Seven metabolites (AMP, aspartate, glutamate, hypoxanthine, lactate, proline, and pyroglutamate) were discriminated between CINs and cervical cancer versus normal (area under the curve (AUC) value > 0.8). The levels of these metabolites were significantly high in patients versus normal (p < 0.0001) and were associated with increased risk of developing CIN2/3 and cervical cancer. Additionally, elevated levels of the seven metabolites combined with positive HPV status were correlated with substantial risk of cancer progression. These results demonstrated that metabolomics profiling is capable of distinguishing CINs and cervical cancers from normal and highlighted potential biomarkers for the early detection of cervical carcinogenesis.

Recent studies have reported the potential role of microbiomes in cervical disease. However, little is known about the microbiome composition and function in cervical carcinogenesis. We aimed to identify the compositional and functional alterations of cervical microbiomes in cases of cervical carcinogenesis of Korean women using shotgun metagenomic sequencing. In this study, using shotgun sequencing, we sequenced the cervical metagenomes of cervical intraneoplasia 2/3 (n = 17), cervical cancer (n = 12), and normal controls (n = 18) to identify the microbial abundances and enriched metabolic functions in cervical metagenomes. At the genus level, the microbiota of cervical cancer were differentially enriched with genera Alkaliphilus, Pseudothermotoga, and Wolbachia. Cervical intraepithelial neoplasia (CIN) 2/3 were enriched with Lactobacillus, Staphylococcus, and Candidatus Endolissoclinum. The normal group was enriched with Pseudoalteromonas and Psychrobacter. Further characterization of the functionalities of the metagenomes may suggest that six Kyoto Encyclopedia of Genes and Genomes (KEGG) orthologies (KOs) that are involved in 10 pathways are associated with an increased risk of CIN2/3 and cervical cancer. Specifically, cervical metagenomes were enriched in the course of peptidoglycan synthesis and depleted by dioxin degradation and 4-oxalocrotonate tautomerase. The Cluster of Orthologous Groups (COG) category ‘Defense mechanisms’ was depleted in cervical cancer patients. Our findings based on shotgun metagenomic sequencing suggest that cervical microbiome community compositions and their metagenomics profiles differed between cervical lesions and normal subjects. Future studies should have larger sample sizes and/or aggregate their results to have sufficient power to detect reproducible and significant associations.