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

Abstract

AIM:To investigate diffusion-weighted imaging (�WI) and positron emission tomography and computed tomography (�ET/CT) with Ⅳ contrast for the preoperative evaluation of pelvic lymph node (LN) metastasis in uterine cancer. METHODS:Twenty-five patients with endometrial or cervical cancer who underwent both �WI and �ET/CT before pelvic lymphadenectomy were included in this study. For area specific analysis, LNs were divided into eight regions: both common iliac, external iliac, internal iliac areas, and obturator areas. The classification for malignancy on �WI was a focally abnormal signal intensity in a location that corresponded to the LN chains on the T1WI and T2WI. The criterion for malignancy on �ET/CT images was increased tracer uptake by the LN. RESULTS:A total of 36 pathologically positive LN areas were found in 9 patients. With �WI, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy for detecting metastatic LNs on an LN area-by-area analysis were 83.3%, 51.2%, 27.3%, 93.3% and 57.0%, respectively, while the corresponding values for �ET/CT were 38.9%, 96.3%, 70.0%, 87.8% and 86.0%. Differences in sensitivity, specificity and accuracy were significant (� < 0.0005).CONCLUSION: �WI showed higher sensitivity and lower specificity than PET/CT. Neither DWI nor PET/CT were sufficiently accurate to replace lymphadenectomy.

Validity of 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography for Pretreatment Evaluation of Patients With Cervical Carcinoma

“…However, PET/CT and DWI were both not accurate enough to replace lymphadenectomy. 21 The PET/CT seems to be more promising than CT in evaluating lymph node metastases. 7,16 The sensitivity and specificity of PET/CT are depending on the stage of cervical cancer.…”

Serum vascular endothelial growth factor-C levels: A possible diagnostic marker for lymph node metastasis in patients with primary non-small cell lung cancer

“…Non-invasive imaging studies, such as CT and magnetic resonance imaging (MRI) scans, are less reliable since the imaging criteria for tumor involvement are morphological, relying on the size and shape of the LNs. With regard to identifying the presence or absence of LNM, the accuracy of CT has been reported to be between 51.4 and 83.0% (8,9). Several studies have described 18 F-fluorodeoxyglucose (FDG)-PET as being advantageous for diagnosing the LN staging of NSCLC.…”

Molecular imaging in the management of gynecologic malignancies

“…The PET falsenegative PLN containing micro-metastasis measured a short axis diameter of only 0.5-6 mm [21]. Kitajima showing that DWI has a higher sensitivity (83.3% vs. 38.9%) but a lower specificity (51.2% vs. 96.3%) than FDG-PET/CT [22]. Kim et al evaluated the additional diagnostic value of FDG-PET and MRI fusion in the detection of metastatic LNs in cervical cancer patients, with the sensitivity and specificity of FDG-PET/CT and fused FDG-PET/MR being 44.1%, 93.9% and 54.2%, 92.7% respectively [23].…”