The Value of Preoperative Positron Emission Tomography/Computed Tomography in Node-Negative Endometrial Cancer on Magnetic Resonance Imaging

• Published in: Annals of surgical oncology Vol. 24; no. 8; pp. 2303 - 2310
• Main Authors: Park, Jeong-Yeol, Lee, Jong Jin, Choi, Hyuck Jae, Song, In Hye, Sung, Chang Ohk, Kim, Hye Ok, Chae, Sun-Young, Kim, Young-Tak, Nam, Joo-Hyun
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.08.2017; Springer Nature B.V
• Subjects: Adenocarcinoma, Clear Cell - diagnostic imaging; Adenocarcinoma, Clear Cell - secondary; Adenocarcinoma, Clear Cell - surgery; Adenocarcinoma, Mucinous - diagnostic imaging; Adenocarcinoma, Mucinous - secondary; Adenocarcinoma, Mucinous - surgery; Adult; Aorta; Biopsy; Cancer; Computed tomography; Cystadenocarcinoma, Serous - diagnostic imaging; Cystadenocarcinoma, Serous - secondary; Cystadenocarcinoma, Serous - surgery; Endometrial cancer; Endometrial Neoplasms - diagnostic imaging; Endometrial Neoplasms - pathology; Endometrial Neoplasms - surgery; Endometrium; Female; Fluorodeoxyglucose F18; Follow-Up Studies; Gynecologic Oncology; Humans; Hysterectomy; Lymph Node Excision; Lymph nodes; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Metastasis; Lymphatic system; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical imaging; Medicine; Medicine & Public Health; Metastases; Metastasis; Middle Aged; NMR; Nuclear magnetic resonance; Oncology; Patients; Pelvis; Positron emission tomography; Positron Emission Tomography Computed Tomography - methods; Preoperative Care; Prognosis; Radiopharmaceuticals; Surgery; Surgical Oncology; Survival Rate; Endometrial Cancer; Predict Lymph Node Status; Fluorodeoxyglucose Positron Emission Tomography-computed Tomography (FDG-PET/CT); Para-aortic Lymph Node Dissection; Deep Circumflex Iliac Vein
• ISSN: 1068-9265; 1534-4681; 1534-4681
• DOI: 10.1245/s10434-017-5901-8

Objective The aim of this study was to investigate the value of [18F]fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in predicting lymph node status in node-negative endometrial cancer on preoperative magnetic resonance imaging (MRI). Methods Patients with endometrial cancer who underwent both preoperative MRI and FDG-PET/CT followed by hysterectomy and lymphadenectomy were initially included. We then enrolled patients with MRI-defined node-negative disease (lymph nodes <1 cm in the short-axis diameter, or no visible lymph node). Histologic examination was the gold standard for lymph node metastasis diagnosis. The diagnostic performance of FDG-PET/CT in predicting lymph node metastasis was calculated in patient-by-patient and lymph node station-by-station analyses. Results On preoperative MRI, 362 patients had no lymph node metastasis. All patients underwent pelvic lymph node dissection and 118 patients underwent further para-aortic lymph node dissection. From 2099 lymph node stations, 10,238 lymph nodes were retrieved. Twenty-seven patients (7.5%) had lymph node metastasis in 49 lymph node stations (2.3%) on pathologic examination. FDG-PET/CT identified lymph node metastasis in five patients (18.5%) and eight lymph node stations (16.3%). The median diameter of false-negative metastatic lymph nodes was 6 mm (range 1–22) in the long axis and 3 mm (range 1–11) in the short axis. For para-aortic lymph nodes, FDG-PET/CT diagnosed 2 of 11 patients (18.1%) with para-aortic lymph node metastasis, and 3 of 12 para-aortic lymph node stations (25%) with metastasis. Conclusion Preoperative FDG-PET/CT has low value in predicting lymph node metastasis in node-negative endometrial cancer on preoperative MRI.