High Diagnostic Value of ¹⁸F-FDG PET/CT in Endometrial Cancer: Systematic Review and Meta-Analysis of the Literature

Abstract

The aim of this study was to evaluate the diagnostic performance of 18 F-FDG PET/CT for the preoperative assessment of lymph node metastases (LNM) in endometrial cancer patients and for the assessment of endometrial cancer recurrence (ECR) after primary surgical treatment. Methods: A comprehensive search was performed on Pubmed/MEDLINE databases for studies reporting the diagnostic performance of 18 F-FDG PET/CT for assessment of LNM and ECR published up to August 15, 2015. Twenty-one studies (13 for LNM and 8 for ECR) were included in the systematic review and meta-analysis. Pooled estimates of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of the 18 F-FDG PET/CT were calculated along with 95% confidence intervals (CIs). A summary receiver-operating-characteristics curve (SROC) was constructed, and the area under the SROC curve (AUC) was determined along with Q* index. Results: The overall pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and AUC (with 95% CI) of 18 F-FDG PET/CT for detection of LNM were 0.72 (95% CI, 0.63-0.80), 0.94 (95% CI, 0.93-0.96), 10.9 (95% CI, 7.9-15.1), 0.36 (95% CI, 0.27-0.48), 39.7 (95% CI, 21.4-73.6), and 0.94 (95% CI, 0.85-0.99), respectively, whereas the corresponding numbers for detection of ECR were 0.95 (95% CI, 0.91-0.98), 0.91 (95% CI, 0.86-0.94), 8.8 (95% CI, 0.08 (95% CI, 171.7 (95% CI,3), and 0.97 (95% CI, 0.95-0.98), respectively. The overall diagnostic accuracy (Q* index) in LNM and ECR were 0.88 and 0.93, respectively. Conclusion: 18 F-FDG PET/CT has an excellent diagnostic performance for detecting LNM preoperatively and disease recurrence postoperatively in endometrial cancer patients.Key Words: endometrial cancer; FDG; PET and CT J Nucl Med 2016; 57:879-885 DOI: 10.2967/jnumed.115.170597 Endomet rial cancer is the most common gynecologic malignancy in the developed countries (1). The prognosis is traditionally determined by clinical and histopathologic factors-that is, age, histologic type, grade, and stage of disease including assessment of cervical invasion, depth of myometrial invasion, lymph node spread, and distant metastases (2-4). The 5-y overall survival rate is generally favorable, around 80%. However, pelvic lymph node metastases (LNM) represents the most common site for extrauterine disease at primary treatment, and the 5-y survival rate is around 50% for this patient subgroup (5).Currently, the final staging of endometrial cancer is based on histopathologic findings at primary surgery, which includes abdominal exploration, peritoneal cytology washing from the pelvis, hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy in selected patients presumed to have a high risk of disease spread (6-8). Routine systemic pelvic lymphadenectomy for earlystage endometrial cancer disease, although not well defined as a surgical technique, improves detection of LNM, but the procedure showed no survival benefit in 2 randomized clinic...

The Combination of Preoperative Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography and Sentinel Lymph Node Mapping in the Surgical Management of Endometrioid Endometrial Cancer

“…Signorelli et al 36 36 In a recent meta-analysis by Bollineni et al, 37 the diagnostic value of PET/CT in the detection of lymph node metastasis in EC was found to be excellent when compared with our results. In our study, PET/CT alone had a very low sensitivity and PPV.…”

Lymph Node Metastasis in Patients With Endometrioid Endometrial Cancer: Overtreatment Is the Main Issue

“…Of these, PET/CT has yielded the most promising results regarding lymphatic metastasis, with a sensitivity of 72% and specificity of 94% according to a very recent meta-analysis. 22 In another study that compared magnetic resonance imaging with PET/CT, the sensitivity of PET/CT for LNM was higher than that of magnetic resonance imaging (70% vs 34%, respectively). 23 Although PET/CT has the highest PPV for lymphatic metastasis, 30% of patients with metastatic nodes may go undiagnosed after PET/CT because of its limited sensitivity.…”

Different imaging techniques for the detection of pelvic lymph nodes metastasis from gynecological malignancies: a systematic review and meta-analysis

“…The result suggests that DWI provided a better performance in distinguishing metastatic lymph node from benign lymph node. In addition, Chang et al [99] and Bollineni et al [9] conducted similar systematic reviews exploring diagnostic efficacy of PET and PET-CT in detection of pelvic lymph node metastasis in endometrial cancer, in which pooled SEN, SPE and AUC ranged from 63% to 72%, 94% to 94.7% and 0.94 to 0.953, respectively. Only 7 and 13 studies were included in Chang's and Bollineni's meta-analysis, respectively.…”

“…However, the accuracy of these imaging modalities is inconstant, as shown by different reports [8, 9]. On the other hand, criteria adopted in the evaluation of lymph node metastasis are inconsistent.…”