Accuracy of 18F-FDG PET/CT in detecting pelvic and paraaortic lymph node metastasis in patients with endometrial cancer.
OBJECTIVE
The objective of our study was to evaluate the accuracy of integrated PET and CT (PET/CT) using (18)F-FDG in detecting pelvic and paraaortic lymph node metastasis in patients with endometrial cancer, using surgical and histopathologic findings as the reference standard.


METHODS
Forty patients with clinical stages IA to IIIC underwent radical hysterectomy, including pelvic lymphadenectomy with or without paraaortic lymphadenectomy, after FDG PET/CT. Lymphadenectomy involved removing all visible lymph nodes in the surgical fields. PET/CT findings were interpreted by two experienced radiologists in consensus and compared with histopathologic results. The criterion for malignancy on PET/CT images was increased radiotracer uptake by a lymph node independent of node size.


RESULTS
In total, 62 pathologically positive nodes were found in 10 patients and 60 of 62 dissected metastatic nodes were identified on the CT component. The overall node-based sensitivity, specificity, and accuracy of PET/CT for detecting nodal metastases were 53.3% (32/60), 99.6% (1,419/1,424), and 97.8% (1,451/1,484), respectively. The sensitivity for detecting metastatic lesions 4 mm or less in diameter was 16.7% (4/24), that for lesions between 5 and 9 mm was 66.7% (14/21), and that for lesions 10 mm or larger was 93.3% (14/15). The overall patient-based sensitivity, specificity, and accuracy were 50% (5/10), 86.7% (26/30), and 77.5% (31/40), respectively.


CONCLUSIONS
Integrated FDG PET/CT is superior to conventional imaging techniques, but it is only moderately sensitive in predicting lymph node metastasis preoperatively in patients with endometrial cancer. Even PET/CT should not replace lymphadenectomy.
Kitajima
Kazuhiro
K
Department of Radiology, Dokkyo University School of Medicine, 880 Kita-kobayashi, Mibu, Shimotuka-gun, Tochigi 321-0293, Japan. kitajima@med.kobe-u.ac.jp
Murakami
Koji
K
Yamasaki
Erena
E
Fukasawa
Ichio
I
Inaba
Noriyuki
N
Kaji
Yasushi
Y
Sugimura
Kazuro
K
D000328:Adult; D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging; D001027:Aortography / Q000379:methods; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18