Carcinoma endometrium: role of 18-FDG PET/CT for detection of suspected recurrence.
OBJECTIVE
Recurrent carcinoma endometrium has a poor prognosis. However, successful salvage with long-term survival has been achieved after hormone therapy, radical surgery, and radiotherapy/chemotherapy in patients with recurrent disease. Conventional imaging (CI) and tumor marker have limited accuracy for detecting recurrence in these patients. The aim of the present study was to evaluate the role of 18-flurodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) in patients suspected to have recurrence of carcinoma endometrium.


METHODS
In this retrospective study, total 101 patients were evaluated. All patients had undergone surgery with/without adjuvant therapy (chemotherapy/radiotherapy/both) for histologically proven carcinoma endometrium. They underwent 18-FDG PET/CT studies for suspected recurrence. Comparable CI (contrast-enhanced CT and/or magnetic resonance imaging) was available for 76 patients. Results of FDG PET/CT were confirmed with clinical/imaging follow-up and/or histopathology.


RESULTS
The mean age was 56.9±8.6 years. 18-FDG PET/CT was positive for recurrence in 51 (50.5%) patients and negative in 50 (49.5%). Locoregional disease was observed in 24 patients, metastatic disease was observed in 10, and 17 showed both locoregional and metastatic disease. The sensitivity, specificity, positive and negative predictive values, and accuracy of 18-FDG PET/CT were 88.9%, 93.6%, 94.1%, 88%, and 91%, respectively. 18-FDG PET/CT showed strong positive correlation with final diagnosis based on reference standard (κ 0.823; P=0.0001). Compared to CI, 18-FDG PET/CT has much higher specificity (62% vs. 96.4%), and accuracy (76.3% vs. 92.1%), with comparable sensitivity (85.1% vs. 89.5%).


CONCLUSIONS
18-FDG PET/CT is a highly sensitive and specific modality for detecting recurrence in post-therapy patients of carcinoma endometrium with suspected recurrence. It performs better than CI.
Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
Punit
P
Sharma
Rakesh
R
Kumar
Harmandeep
H
Singh
Sunil
S
Jeph
Daya Nand
DN
Sharma
Chandrasekhar
C
Bal
Arun
A
Malhotra
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000628:therapy; D000328:Adult; D000368:Aged; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D012008:Recurrence; D014057:Tomography, X-Ray Computed
D019788:Fluorodeoxyglucose F18