PET/CT imaging analysis of recurrent sites and patterns of spread following modified radical surgery (type B) for stage Ib-IIa cervical cancer

The aim of the present study was to use imaging to retrospectively analyze the recurrent sites and patterns of spread of early cervical cancer following radical surgery. A total of 86 patients with cervical cancer (stage IB or IIA) showed postoperative pelvic recurrences and distant metastases. Based on positron emission tomography or computed tomography, the correlation between clinicopathologic factors and sites of recurrence was determined and the pattern of spread was evaluated. Among the 86 patients with postoperative recurrence of early cervical cancer, 76 exhibited pelvic recurrence involving the cardinal and uterosacral ligaments. Other recurrences were paravaginal (n=14) and vaginal (n=10). Seven cases of recurrence were in the pelvic lymph nodes and 10 patients had distant metastases. The rate of paracervical ligament recurrence in patients with stromal invasion ≥1/2 depth was higher, compared with that in patients with stromal invasion <1/2 depth, however, the difference was not statistically significant. The rate of distant metastases in patients with positive pelvic lymph nodes was higher, compared with that in patients with negative lymph nodes (P=0.001). Recurrent lesions spread along the residual ligament to the lateral pelvic wall. It was found that, following radical surgery for early cervical cancer, recurrent tumor spread was predominantly confined to the subperitoneal residual ligaments of the cervix and vagina. For patients with positive lymph nodes, the incidence of distant metastases increased significantly.