Preoperative detection of lymph node metastasis in endometrial cancer: The role of 18-FDG PET/CT

Authors

Keywords:

Endometrial cancer, Lymph node metastasis, 18F- FDG-PET/CT, Ratio, Prognosis

Abstract

Aim: Fluorine-18 2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/CT imaging technique combines the advantages of localization and functional imaging, and thus has become a preferred method for detection of metastases to the lymph nodes (LN) of patients with endometrial cancer. The aim of this study was to evaluate the efficacy of 18F-FDG PET/CT imaging results in the detection of metastasis of endometrial cancer to lymph nodes.

Methods: This is a retrospective cohort study conducted between 2009 and 2015. The study group consisted of females who were admitted to our clinic and diagnosed with endometrial cancer (n=135). We included patients who underwent LN dissection with pre-operative 18F-FDG PET / CT imaging, and evaluated the capability of this method in terms of its effectiveness in determining metastases to the lymph nodes. Assessments and comparisons were performed with gold-standard pathological methods. 

Results: The 18F-FDG PET/CT method for identification of lymph node metastases had a sensitivity of 76%, a specificity of 80%, a positive predictive value of 46.34% and a negative predictive value of 93.62%. The overall diagnostic accuracy was 79.26%.

Conclusion: Our analysis suggests that 18F-FDG PET/CT has a high negative predictive value with regards to lymph node metastasis in endometrial cancer and may be used effectively in evaluating lymph node metastasis in this cohort.

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References

Lortet-Tieulet J, Ferlay J, Bray F, Jemal A. International Patterns and Trends in Endometrial Cancer Incidence, 1978–2013. J Natl Cancer Inst. 2017;110:354-61.

Denschlag DU, Emons G. The diagnosis and treatment of endometrial cancer: progress and controversies. Dtsch Arztebl Int. 2011;108:571-7.

Tran AQ, Gehrig P. Recent Advances in Endometrial Cancer. F1000Research. 2017;6:81.

Uharcek P. Prognostic factors in endometrial carcinoma. J Obstet Gynaecol Res. 2008;34:776-83.

Tschernichovsky R, Diver EJ, Schorge JO, Goodman A. The Role of Lymphadenectomy Versus Sentinel Lymph Node Biopsy in Early-stage Endometrial Cancer: A Review of the Literature. Am J Clin Oncol. 2016;39:516-21.

Nayyar N, Lakhwani P, Goel A, Pande PK, Kumar K. The Futility of Systematic Lymphadenectomy in Early-Stage Low-grade Endometrial Cancer. Indian J Surg Oncol. 2018;9:204-10.

Kyrgiou M, Swart AM, Qian W, Warwick J. A Comparison of Outcomes Following Laparoscopic and Open Hysterectomy With or Without Lymphadenectomy for Presumed Early-Stage Endometrial Cancer: Results From the Medical Research Council ASTEC Trial. Int J Gynecol Cancer. 2015;25:1424-36.

El-Agwany AS, Meleis MH. Value and best way for detection of Sentinel lymph node in early stage endometrial cancer: Selective lymphadenectomy algorithm. Eur J Obstet Gynecol Reprod Biol. 2018;225:35-9.

Soneji ND, Bharwani N, Ferri A, Stewart V, Rockall A. Pre-operative MRI staging of endometrial cancer in a multicentre cancer network: can we match single centre study results? Eur Radio. 2018;28:4725-34.

Kim HJ, Cho A, Yun M, Kim YT, Kank WJ. Comparison of FDG PET/CT and MRI in lymph node staging of endometrial cancer. Ann Nucl Med. 2016;30:104-13.

Sala E, Rockall AG, Freemen SJ, Mitchell DG, Reinhod C. The added role of MR imaging in treatment stratification of patients with gynecologic malignancies: what the radiologist needs to know. Radiology. 2013;266:717-40.

Bollineni VR, Ytre-Hauge S, Bollineni-Balabay O, Salvesen HB, Haldorsen IS. High Diagnostic Value of 18F-FDG PET/CT in Endometrial Cancer: Systematic Review and Meta-Analysis of the Literature. J Nucl Med. 2016;57:879-85.

Sager O, Dincoglan F, Demiral S, Uysal B, Gamsiz H, Elcim Y, et al. Utility Of Molecular Imaging With 2-Deoxy-2-[Fluorine-18] Fluoro-D-Glucose Positron Emission Tomography (18f-Fdg Pet) For Small Cell Lung Cancer (Sclc): A Radiation Oncology Perspective. Curr Radiopharm. 2018.

Beinat C, Haywood T, Chen YS, Patel CB, Alam IS, Murty S, et al. The Utility of [(18)F]DASA-23 for Molecular Imaging of Prostate Cancer with Positron Emission Tomography. Mol Imaging Biol. 2018;20:1015-24.

Gambhir SS, Molecular imaging of cancer with positron emission tomography. Nat Rev Cancer. 2002;2:683-93.

Kitajima K, Suenaga Y, Ueno Y, Maeda T, Ebina Y, Yamada H, et al. Preoperative risk stratification using metabolic parameters of (18)F-FDG PET/CT in patients with endometrial cancer. Eur J Nucl Med Mol Imaging. 2015;42:1268-75.

Dolanbay M, Ozcelik B, Abdulrezzak U, Serin İS, Uludag S. F-18 fluoro-D-glucose (FDG)-positron emission tomography (PET)/computed tomography (CT) in planning of surgery and sentinel lymph node screening in vulvar cancers. Arch Gynecol Obstet. 2016;293:1319-24.

Picchio M, Mangili G, Samanes Gajate AM, De Marzi P, Spinapolice EG, Mapelli P, et al. High-grade endometrial cancer: value of [(18)F]FDG PET/CT in preoperative staging. Nucl Med Commun. 2010;31:506-12.

Chang MC, Chen JH, Liang JA, Yang KT, Cheng KY, Kao CH. 18F-FDG PET or PET/CT for detection of metastatic lymph nodes in patients with endometrial cancer: A systematic review and meta-analysis. European Journal of Radiology. 2012;81:3511-7.

Atri M, Zhang Z, Dehdashti F, Lee SI, Marques H, Ali S, et al. Utility of PET/CT to Evaluate Retroperitoneal Lymph Node Metastasis in High-Risk Endometrial Cancer: Results of ACRIN 6671/GOG 0233 Trial. Radiology. 2017;283:450-9.

Lee SI, Russell AH. Performance of 18F-FDG PET/CT in Endometrial Cancer. American Journal of Roentgenology. 2008;191:W210.

Crivellaro C, Signorelli M, Guerra L, De Ponti E, Pirovano C, Fruscio R, et al. Tailoring systematic lymphadenectomy in high-risk clinical early stage endometrial cancer: the role of 18F-FDG PET/CT. Gynecol Oncol. 2013;130:306-11.

Signorelli M, Guerra L, Buda A, Picchio M, Mangili G, Dell'Anna T, et al. Role of the integrated FDG PET/CT in the surgical management of patients with high risk clinical early stage endometrial cancer: detection of pelvic nodal metastases. Gynecol Oncol. 2009;115:231-5.

Suga T, Nakamoto Y, Saga T, Higashi T, Hamanaka Y, Tatsumi M, et al. Clinical value of FDG-PET for preoperative evaluation of endometrial cancer. Ann Nucl Med. 2011;25:269-75.

Nakamura K, Hongo A, Kodoma J, Hiramatsu Y. The measurement of SUVmax of the primary tumor is predictive of prognosis for patients with endometrial cancer. Gynecol Oncol. 2011;123:82-7.

Nogami Y, Banno K, Irie H, Iida M, Kisu I, Masugi Y, et al. The efficacy of preoperative positron emission tomography-computed tomography (PET-CT) for detection of lymph node metastasis in cervical and endometrial cancer: clinical and pathological factors influencing it. Jpn J Clin Oncol. 2014;45:26-34.

H Horowitz NS, Dehdashti F, Herzog TJ, Rader JS, Powell MA, Gibb RK, et al. Prospective evaluation of FDG-PET for detecting pelvic and para-aortic lymph node metastasis in uterine corpus cancer. Gynecol Oncol. 2004;95:546-51.

Antonsen SL, Loft A, Fisker R, Nielsen AL, Andersen ES, Høgdall E, et al. SUVmax of 18FDG PET/CT as a predictor of high-risk endometrial cancer patients. Gynecol Oncol. 2013;129:298-303.

Sironi S, Buda A, Picchio M, Perego P, Moreni R, Pellegrino A, et al. Lymph Node Metastasis in Patients with Clinical Early-Stage Cervical Cancer: Detection with Integrated FDG PET/CT. Radiology. 2006;238:272-9.

Reinhardt, MJ, Ehritt-Braun C, Vogelgesang D. Metastatic Lymph Nodes in Patients with Cervical Cancer: Detection with MR Imaging and FDG PET. Radiology. 2001;218:776-82.

Sironi S, Messa C, Mangili G. Integrated FDG PET/CT in Patients with Persistent Ovarian Cancer: Correlation with Histologic Findings. Radiology. 2004;233:433-40.

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Published

2019-09-01

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Research Article

How to Cite

1.
Taş M, Yavuz A, Dolanbay M, Kaya E, Öner G, Özçelik B. Preoperative detection of lymph node metastasis in endometrial cancer: The role of 18-FDG PET/CT. J Surg Med [Internet]. 2019 Sep. 1 [cited 2022 Aug. 8];3(9):681-4. Available from: https://jsurgmed.com/article/view/619609