Diagnostic Imaging of Lymph Nodes in Gynaecologic Oncology
Diagnostic Imaging of Lymph Nodes in Gynaecologic Oncology
The purpose of the study is to determine the diagnostic accuracy of a new magnetic resonance
 imaging (MRI) technique, the diffusion weighted imaging with body background signal
 suppression (DWIBS) in the detection of lymph node pathology in patients with gynaecologic
 malignancies.
The presence of lymph node metastases indicates a poor prognosis, with a marked decrease in
 5-year survival rate. Lymph node involvement is an important factor in the choice of adjuvant
 treatment in gynaecological malignancies. Surgical lymphadenectomy is the gold standard for
 the diagnosis of lymph node metastases. This is a highly specialized procedure with increase
 in operative time and cost, and risk of surgery-related morbidity. Therefore, a non-invasive
 technique that accurately identifies lymph node metastasis would be beneficial. Diffusion
 Weighted whole body Imaging with Background Signal suppression (DWIBS) is a new imaging
 technique, which lightens lymph nodes and possibly differentiates normal and hyperplastic
 from metastatic lymph nodes. Cancer metastases in lymph nodes may be associated with
 alterations in water diffusivity and microcirculation within the node. It is also likely that
 cell density might play an important role. So far, no feasibility studies have will be
 evaluated for its accuracy, effectiveness, and feasibility in detecting lymph node metastases
 in gynaecological malignancies, as a possible alternative for the surgical staging method.
 The accuracy of a pelvic lymph node dissection (reference test) will also be evaluated by
 performing a post-operative DWIBS scan.
Inclusion Criteria:

 -  Patients with

 -  Cervical cancer stage Ia2-Ib, IIa

 -  Endometrial cancer stage I (high risk), II

 -  Ovarian cancer stage I, IIa-IIa

 -  Vulvar cancer stage I, II

 -  Age > 18 years

 -  Karnofsky score > 70

 Exclusion Criteria:

 -  Eligible for the PORTEC II trial

 -  Contra-indications to the MRI: surgical clips in the brain, a pacemaker and
 claustrophobia