title: Tailoring systematic lymphadenectomy in high-risk clinical early stage endometrial cancer: the role of 18F-FDG PET/CT.
abstract: OBJECTIVE
  To evaluate the role of FDG PET/CT in the preoperative N-staging of high-risk clinical stage I endometrial cancer. The correlation between the metabolic characteristics of endometrial tumor uptake as predictors of a) lymph-node (LN) metastases and b) recurrence, was also evaluated.
  
  
  METHODS
  Seventy-six high-risk (G2 with deep myometrial invasion, G3, serous/clear-cell carcinoma) clinical stage I endometrial cancer patients underwent preoperative PET/CT scan followed by total hysterectomy, bilateral salpingo-oophorectomy and lymphadenectomy. PET/CT images were analyzed and correlated to histological findings. Maximal and mean standardized uptake value (SUVmax, SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG, defined as the product between SUVmean and MTV) of endometrial lesions were calculated and correlated to: a) presence of LN metastases, b) recurrences.
  
  
  RESULTS
  PET/CT resulted positive at LNs in 12/76 patients: 11/12 truly positive, 1/12 falsely positive. Conversely PET/CT was negative in 64/76 patients: 61/64 truly negative and 3/64 falsely negative. On pt-based analysis, sensitivity, specificity, accuracy, positive and negative predictive value of PET/CT in detecting LN metastases were 78.6%, 98.4%, 94.7%, 91.7%, 95.3%, respectively. A significant association was found between the presence of LN metastases and SUVmax (p=0.038), MTV (p=0.007), TLG (p=0.003) of the primary tumor. No correlations were found between the metabolic parameters and relapse (median follow-up 25.4months).
  
  
  CONCLUSIONS
  In high-risk clinical stage I endometrial cancer FDG PET/CT demonstrated moderate sensitivity, high specificity and accuracy for the nodal status assessment. SUVmax, MTV and TLG of the primary tumor are significantly correlated to LN metastases, while none of these parameters is predictor of recurrence.
authors.affiliation: Fondazione Tecnomed, University Milano-Bicocca, Milan, Italy. cinzia.crivellaro@alice.it
authors.forename: Cinzia
authors.initials: C
authors.lastname: Crivellaro
authors.forename: Mauro
authors.initials: M
authors.lastname: Signorelli
authors.forename: Luca
authors.initials: L
authors.lastname: Guerra
authors.forename: Elena
authors.initials: E
authors.lastname: De Ponti
authors.forename: Cecilia
authors.initials: C
authors.lastname: Pirovano
authors.forename: Robert
authors.initials: R
authors.lastname: Fruscio
authors.forename: Federica
authors.initials: F
authors.lastname: Elisei
authors.forename: Luca
authors.initials: L
authors.lastname: Montanelli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Buda
authors.forename: Cristina
authors.initials: C
authors.lastname: Messa
mesh_terms: D000368:Aged; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Endometrial cancer; High-risk; PET/CT; Staging