title: Staging of High-Risk Endometrial Cancer With PET/CT and Sentinel Lymph Node Mapping.
abstract: OBJECTIVE
  The aim of this study was to evaluate the role of PET/CT and sentinel lymph node (SLN) biopsy in staging high-risk endometrial cancer patients (G2 and deep myometrial invasion, G3, serous clear cell carcinoma or carcinosarcoma) in early clinical stage.
  
  
  METHODS
  From January 2006 to December 2012, high-risk early-stage endometrial cancer patients performing PET/CT scan followed by surgery (systematic pelvic ± aortic lymphadenectomy) were included. From December 2010, SLN mapping with Tc-albumin nanocolloid and blue dye cervical injection was included in our clinical practice and additionally performed. Histological findings were used as the reference standard.
  
  
  RESULTS
  Ninety-three patients were included, of which 22 of 93 had both PET/CT and SLN biopsy. The median number of dissected lymph nodes (LNs) was 28. Nineteen women (20.4%) had pelvic LN metastases; 14 were correctly identified by PET/CT. Among 5 false-negative cases, 3 occurred after the introduction of SLN mapping due to detection of micrometastases by ultrastaging. On overall patient-based analysis, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of PET/CT for pelvic LN metastases were 73.7%, 98.7%, 93.6%, 93.3%, 93.6%, respectively.
  
  
  CONCLUSIONS
  PET/CT demonstrated moderate sensitivity and high specificity in detecting pelvic LN metastases; its high positive predictive value (93.3%) is useful to refer patients to appropriate debulking surgery. Sentinel LN mapping and histological ultrastaging increased the identification of metastases (incidence, 18.3%-27.3%) not detectable by PET/CT because of its spatial resolution. The combination of both modalities is promising for nodal staging purpose.
authors.affiliation: From the Departments of *Obstetrics and Gynecology, and †Nuclear Medicine, San Gerardo Hospital, Monza; ‡Tecnomed Foundation, and §University Milan-Bicocca, Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Signorelli
authors.forename: Cinzia
authors.initials: C
authors.lastname: Crivellaro
authors.forename: Alessandro
authors.initials: A
authors.lastname: Buda
authors.forename: Luca
authors.initials: L
authors.lastname: Guerra
authors.forename: Robert
authors.initials: R
authors.lastname: Fruscio
authors.forename: Federica
authors.initials: F
authors.lastname: Elisei
authors.forename: Carlotta
authors.initials: C
authors.lastname: Dolci
authors.forename: Marco
authors.initials: M
authors.lastname: Cuzzocrea
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Milani
authors.forename: Cristina
authors.initials: C
authors.lastname: Messa
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000000981:diagnostic imaging* / Q000473:pathology; D000328:Adult; D000368:Aged; D002296:Carcinosarcoma / Q000000981:diagnostic imaging* / Q000473:pathology; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D021701:Sentinel Lymph Node Biopsy; D014057:Tomography, X-Ray Computed