title: Role of the integrated FDG PET/CT in the surgical management of patients with high risk clinical early stage endometrial cancer: detection of pelvic nodal metastases.
abstract: BACKGROUND
  High risk clinical stage I endometrial cancer (grade 2 and deep myometrial invasion, grade 3 and serous and clear-cell carcinoma) had 10-35% of nodal involvement. Surgical staging is considered reasonable in this setting of women, although unnecessary in 70-90%. The purpose of this study was to determine prospectively the diagnostic accuracy of 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography 18F-FDG PET/CT in the detection of nodal metastases in patients with high risk endometrial cancer.
  
  
  METHODS
  Eleven women with grade 2 and deep myometrial invasion and 26 with grade 3 endometrial cancer underwent 18F-FDG PET/CT, followed by total hysterectomy, bilateral salpingo-oophorectomy and systematic pelvic lymphadenectomy. Histopathological findings served as the reference standard. Diagnostic performance of 18F-FDG PET/CT in nodal disease detection was reported in terms of accuracy value both in a patient-based and a lesion site-based analysis.
  
  
  RESULTS
  Pelvic nodes metastases were found at histopathological analysis in 9 of the 37 patients (24.3%). Patient-based sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 18F-FDG PET/CT for detection of nodal disease were 77.8%, 100.0%, 100.0%, 93.1% and 94.4%, respectively. Nodal lesion site-based sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 18F-FDG PET/CT were 66.7%, 99.4%, 90.9%, 97.2% and 96.8%, respectively.
  
  
  CONCLUSIONS
  This study shows that 18F-FDG PET/CT is an accurate method for the presurgical evaluation of pelvic nodes metastases. The high negative predictive value may be useful in selecting patients who only may benefit from lymphadenectomy, minimizing operative and surgical complications.
authors.affiliation: Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, University of Milan-Bicocca, Milan, Italy. maurosignorelli@inwind.it
authors.forename: Mauro
authors.initials: M
authors.lastname: Signorelli
authors.forename: Luca
authors.initials: L
authors.lastname: Guerra
authors.forename: Alessandro
authors.initials: A
authors.lastname: Buda
authors.forename: Maria
authors.initials: M
authors.lastname: Picchio
authors.forename: Giorgia
authors.initials: G
authors.lastname: Mangili
authors.forename: Tiziana
authors.initials: T
authors.lastname: Dell'Anna
authors.forename: Sandro
authors.initials: S
authors.lastname: Sironi
authors.forename: Cristina
authors.initials: C
authors.lastname: Messa
mesh_terms: D000368:Aged; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D010388:Pelvis / Q000000981:diagnostic imaging; D049268:Positron-Emission Tomography / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18