18F-FDG PET or PET/CT for detection of metastatic lymph nodes in patients with endometrial cancer: a systematic review and meta-analysis.
The present study assessed the diagnostic performances of 18F-FDG PET or PET/CT in detecting pelvic and/or paraaortic lymph node metastasis in patients with endometrial cancer.


METHODS
Through a search of MEDLINE (January 1998 to March 2011), an overall weighted average for sensitivity and specificity as well as pooled estimates of positive and negative likelihood ratios were calculated. A summary receiver-operating-characteristics (sROC) curve was constructed and the area under the sROC curve (AUC) was calculated. I-square was calculated to explore heterogeneity.


RESULTS
The present study included 243 patients from seven studies. Results indicated a lack of significant heterogeneity for sensitivity and specificity (I2<50% and p>0.05). The overall pooled estimates for sensitivity and specificity of FDG-PET or PET/CT scans in the detection of pelvic and/or paraaortic metastasis were 63.0% (95% CI, 48.7-75.7%) and 94.7% (95% CI, 90.4-97.4%), respectively. The positive likelihood ratio was 10.465 (95% CI, 5.646-19.396) and the negative likelihood ratio 0.399 (95% CI, 0.284-0.560). The AUC was 0.9533. The overall diagnostic accuracy (Q* index) was 89.5%. Conclusion The high positive likelihood value confirms the reliability of a positive FDG-PET or PET/CT to detect pelvic and/or paraaortic lymph nodes metastasis in patients with untreated endometrial cancer. FDG-PET or PET/CT may prove beneficial to surgeons when selecting appropriate patients on whom to perform lymphadenectomy.
Nuclear Medicine Department, Changhua Christian Hospital, Changhua, Taiwan. 135834@cch.org.tw
Ming-Che
MC
Chang
Jin-Hua
JH
Chen
Ji-An
JA
Liang
Kuang-Tao
KT
Yang
Kai-Yuan
KY
Cheng
Chia-Hung
CH
Kao
D002277:Carcinoma / Q000175:diagnosis* / Q000453:epidemiology*; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008207:Lymphatic Metastasis; D064847:Multimodal Imaging / Q000706:statistics & numerical data*; D049268:Positron-Emission Tomography; D015995:Prevalence; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18