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Comparison of FDG PET/CT and MRI in lymph node staging of endometrial cancer

 Hyun Jeong Kim  ;  Arthur Cho  ;  Mijin Yun  ;  Young Tae Kim  ;  Won Jun Kang 
 ANNALS OF NUCLEAR MEDICINE, Vol.30(2) : 104-113, 2016 
Journal Title
Issue Date
Adult ; Aged ; Endometrial Neoplasms/diagnosis* ; Endometrial Neoplasms/pathology* ; Endometrial Neoplasms/surgery ; Female ; Fluorodeoxyglucose F18* ; Humans ; Lymphatic Metastasis ; Magnetic Resonance Imaging* ; Middle Aged ; Multimodal Imaging ; Neoplasm Staging/methods* ; Positron-Emission Tomography* ; Preoperative Period ; Retrospective Studies ; Tomography, X-Ray Computed*
18F-fluoro-2-deoxy-D-glucose positron emission tomography ; Endometrial cancer ; Lymph node ; Staging
OBJECTIVE: Endometrial cancer is the most frequent cancer occurring in the female genital tract in the Western countries. Because surgical staging is currently the standard, noninvasive techniques that accurately identify lymph node (LN) metastases would be beneficial by reducing costs and complications. The purpose of our study is to compare the diagnostic accuracy of 2-[(18)F]fluoro-2-deoxy-D-glucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) with that of magnetic resonance imaging (MRI) for detecting LN metastases in the preoperative staging of endometrial cancer.
METHODS: Two hundred eighty-seven consecutive patients with endometrial cancer underwent preoperative PET/CT and MRI for staging. The malignancy criteria for LNs were a short diameter of 1 cm or more by MRI and focally increased (18)F-FDG uptake by PET/CT. After evaluating PET/CT and MRI separately, morphologic and functional image findings were compared with the histological findings regarding LN metastasis for all patients. PET/CT and MRI images were classified on the basis of histological findings as true-positive, true-negative, false-positive, or false-negative. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated.
RESULTS: Histologic examination revealed LN metastases in 51 patients (17.8%). The maximal standardized uptake values (SUVmax) of the primary lesions by PET/CT ranged from 1.4 to 37.7, with a mean value of 9.3, whereas those of the metastatic LNs ranged from 2.0 to 22.5 with a mean of 7.3. On a per-patient basis, node staging resulted in sensitivities of 70.0% with (18)F-FDG PET/CT and 34.0% with MRI, and specificities of 95.4 % with PET/CT and 95.0% with MRI. The NPV of PET/CT was 94.3%, and that of MRI was 87.2%. On a lesion base analysis, sensitivity of PET/CT was 79.4% while that of MRI was 51.6%. In detecting distant metastasis, the sensitivity, specificity, accuracy, PPV, and NPV of PET/CT were 92.9, 98.9, 98.6, 81.3, and 99.6%, respectively.
CONCLUSION: Diagnostic performance of FDG PET/CT was better than MRI for detecting metastatic lymph nodes in patients with endometrial cancer both by patient basis and lesion basis analyses. Due to high NPV, FDG PET-CT could aid in selecting candidates for lymphadenectomy.
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1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Obstetrics and Gynecology (산부인과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Won Jun(강원준) ORCID logo https://orcid.org/0000-0002-2107-8160
Kim, Young Tae(김영태) ORCID logo https://orcid.org/0000-0002-7347-1052
Kim, Hyun Jeong(김현정) ORCID logo https://orcid.org/0000-0002-3116-8848
Yun, Mi Jin(윤미진) ORCID logo https://orcid.org/0000-0002-1712-163X
Cho, Arthur Eung Hyuck(조응혁) ORCID logo https://orcid.org/0000-0001-8670-2473
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