Accuracy of integrated FDG-PET/contrast-enhanced CT in detecting pelvic and paraaortic lymph node metastasis in patients with uterine cancer

Abstract

The purpose is to evaluate the accuracy of integrated (18)F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography ((CT) with intravenous contrast medium in detecting pelvic and paraaortic lymph node metastasis in patients with uterine cancer, with surgical and histopathological findings used as the reference standard. Forty-five patients with endometrial or uterine cervical cancer underwent radical hysterectomy, including pelvic lymphadenectomy with or without paraaortic lymphadenectomy, after PET/CT. PET/CT findings were interpreted by two experienced radiologists in consensus. The criterion for malignancy on PET/CT images was increased tracer uptake by the lymph node, independent of node size. The overall node-based sensitivity, specificity, PPV, NPV and accuracy of PET/CT for detecting nodal metastases were 51.1% (23/45), 99.8% (1,927/1,931), 85.2% (23/27), 98.9% (1,927/1,949) and 98.7% (1,950/1,976), respectively. The sensitivity for detecting metastatic lesions 4 mm or less in short-axis diameter was 12.5% (2/16), that for between 5 and 9 mm was 66.7% (16/24), and that for 10 mm or larger was 100.0% (5/5). The overall patient-based sensitivity, specificity, positive predictive value ((PPV), negative predictive value (NPV), and accuracy were 50% (6/12), 90.9% (30/33), 66.7% (6/9), 83.3% (30/36) and 80.0% (36/45), respectively. Integrated FDG-PET/contrast-enhanced CT is superior to conventional imaging, but only moderately sensitive in predicting lymph node metastasis preoperatively in patients with uterine cancer.

Hybrid versus fusion imaging: are we moving forward judiciously?

“…These data are further confirmed by Kitajima and colleagues in a series of studies in patients with uterine, ovarian, colorectal and pancreas cancer [8][9][10][11][12][13].…”

The Role of Chest Computed Tomography in the Work-up of Patients with Cervical or Endometrial Cancer

“…PET scan is superior in the detection of lymph node metastasis compared to conventional imaging [27][28][29]. Patz et al evaluated a variety of focal pulmonary abnormalities by using a FDG PET, and determined a threshold of standardized uptake ratio (SUR) of 2.5 for optimal sensitivity and specificity of benign lesions.…”

Comparison of DWI and PET/CT in evaluation of lymph node metastasis in uterine cancer

“…Conversely, LNs with no detectable tracer uptake were deemed negative for metastatic spread, even if their short-axis diameter was larger than 1 cm. Semiquantitative analysis to determine a standardized value for FDG uptake in the nodal lesions was not performed in our series, in line with the PET/CT image analysis method of several other studies [26][27][28][29][30][31] .…”

“…There have been several reports demonstrating the accuracy of FDG-PET/CT for detecting LN metastasis in uterine cancer [20,[26][27][28][29][30][31] . They revealed the sensitivity, specificity, and accuracy of PET/CT on region-specific analyses were 36%-72%, 88%-99% and 84%-99%, respectively, and that corresponding values for patient-based analyses were 41%-77%, 56%-100% and 76%-89%.…”

“…These modalities include diffusion-weighted imaging (DWI) of MRI, MRI with ultrasmall superparamagnetic iron oxide (USPIO) [13,21,22] , and positron emission tomography and CT (PET/CT) using 18 F-fluorodeoxyglucose (FDG). To date, there have been three reports on apparent diffusion coefficient (ADC) obtained with DWI for the detection of LN metastasis [23][24][25] and several on PET/CT [20,[26][27][28][29][30][31] for uterine cancer. To the best of our knowledge, there have been no studies comparing the diagnostic accuracy of DWI and PET/CT for preoperative evaluation of LNs in patients with uterine cancer.…”