title: Utility of PET/CT to Evaluate Retroperitoneal Lymph Node Metastasis in High-Risk Endometrial Cancer: Results of ACRIN 6671/GOG 0233 Trial.
abstract: Purpose To assess the diagnostic accuracy of fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) combined with diagnostic contrast material-enhanced computed tomography (CT) in detecting lymph node (LN) metastasis in high-risk endometrial cancer. Materials and Methods This prospective multicenter HIPAA-compliant study had institutional review board approval, and all participants gave written informed consent. Data were accrued between January 2010 and June 2013. Patients underwent PET/CT and pelvic and abdominal lymphadenectomy. Two hundred seven of 215 enrolled patients had PET/CT and pathologic examination results for the abdomen and pelvis. Mean patient age was 62.7 years ± 9.6 (standard deviation). Data in all 23 patients with a positive abdominal examination and in 26 randomly selected patients with a negative abdominal examination were used for this central reader study. Seven independent blinded readers reviewed diagnostic CT and PET/CT results in different sessions 1 month apart. Accuracy was calculated at the participant level, correlating abdominal (right and left para-aortic and common iliac) and pelvic (right and left external iliac and obturator) LN regions with pathologic results, respecting laterality. Reader-average sensitivities, specificities, and areas under the receiver operating characteristic curve (AUCs) of PET/CT and diagnostic CT were compared. Power calculation was for sensitivity and specificity in the abdomen. Results Sensitivities of PET/CT versus diagnostic CT for the detection of LN metastasis were 0.65 (95% confidence interval [CI]: 0.57, 0.72) versus 0.50 (95% CI: 0.43, 0.58) (P = .01) in the abdomen and 0.65 (95% CI: 0.57, 0.72) versus 0.48 (95% CI: 0.41, 0.56) (P = .004) in the pelvis. Corresponding specificities were 0.88 (95% CI: 0.83, 0.92) versus 0.93 (95% CI: 0.89, 0.96) (P = .11) and 0.93 (95% CI: 0.86, 0.96) versus 0.89 (95% CI: 0.82, 0.94) (P = .27), and AUCs were 0.78 (95% CI: 0.66, 0.89) versus 0.74 (95% CI: 0.63, 0.86) (P = .39) and 0.82 (95% CI: 0.71, 0.92) versus 0.73 (95% CI: 0.63, 0.84) (P = .02). Conclusion FDG PET/CT has satisfactory diagnostic accuracy in the detection of abdominal LN metastasis in high-risk endometrial cancer. Compared with diagnostic CT alone, addition of PET to diagnostic CT significantly increased sensitivity in both the abdomen and pelvis while maintaining high specificity.©RSNA, 2017 Online supplemental material is available for this article.
authors.affiliation: From the Department of Medical Imaging, NCSB 1C569 Toronto General Hospital, University of Toronto, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2 (M.A.); Center for Statistical Sciences, Brown University, Providence, RI (F.D., H.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.D.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); Roswell Park Cancer Institute, Buffalo, NY (S.A.); Department of Radiation Oncology, University of Washington Medical Center, Seattle, Wash (W.J.K.); University of Oklahoma Health Sciences Center, Oklahoma City, Okla (R.S.M., K.M.M.); Department of Gynecologic Oncology, Women and Infants Hospital, Providence, RI (P.D.); Seattle Cancer Care Alliance, Seattle, Wash (S.A.K.); School of Medicine, Stony Brook University Health Sciences Center, Stony Brook, NY (M.P.); Department of Gynecologic Oncology, University of Connecticut School of Medicine Hartford HealthCare Cancer Institute at the Hospital of Central Connecticut, New Britain, Conn (X.C.Z.); Department of Obstetrics and Gynecology, Laval University, Quebec City, Quebec, Canada (M.P.); and Department of Gynecologic Oncology, Tulsa Cancer Institute, Tulsa, Okla (M.G.).
authors.forename: Mostafa
authors.initials: M
authors.lastname: Atri
authors.affiliation: From the Department of Medical Imaging, NCSB 1C569 Toronto General Hospital, University of Toronto, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2 (M.A.); Center for Statistical Sciences, Brown University, Providence, RI (F.D., H.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.D.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); Roswell Park Cancer Institute, Buffalo, NY (S.A.); Department of Radiation Oncology, University of Washington Medical Center, Seattle, Wash (W.J.K.); University of Oklahoma Health Sciences Center, Oklahoma City, Okla (R.S.M., K.M.M.); Department of Gynecologic Oncology, Women and Infants Hospital, Providence, RI (P.D.); Seattle Cancer Care Alliance, Seattle, Wash (S.A.K.); School of Medicine, Stony Brook University Health Sciences Center, Stony Brook, NY (M.P.); Department of Gynecologic Oncology, University of Connecticut School of Medicine Hartford HealthCare Cancer Institute at the Hospital of Central Connecticut, New Britain, Conn (X.C.Z.); Department of Obstetrics and Gynecology, Laval University, Quebec City, Quebec, Canada (M.P.); and Department of Gynecologic Oncology, Tulsa Cancer Institute, Tulsa, Okla (M.G.).
authors.forename: Zheng
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: From the Department of Medical Imaging, NCSB 1C569 Toronto General Hospital, University of Toronto, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2 (M.A.); Center for Statistical Sciences, Brown University, Providence, RI (F.D., H.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.D.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); Roswell Park Cancer Institute, Buffalo, NY (S.A.); Department of Radiation Oncology, University of Washington Medical Center, Seattle, Wash (W.J.K.); University of Oklahoma Health Sciences Center, Oklahoma City, Okla (R.S.M., K.M.M.); Department of Gynecologic Oncology, Women and Infants Hospital, Providence, RI (P.D.); Seattle Cancer Care Alliance, Seattle, Wash (S.A.K.); School of Medicine, Stony Brook University Health Sciences Center, Stony Brook, NY (M.P.); Department of Gynecologic Oncology, University of Connecticut School of Medicine Hartford HealthCare Cancer Institute at the Hospital of Central Connecticut, New Britain, Conn (X.C.Z.); Department of Obstetrics and Gynecology, Laval University, Quebec City, Quebec, Canada (M.P.); and Department of Gynecologic Oncology, Tulsa Cancer Institute, Tulsa, Okla (M.G.).
authors.forename: Farrokh
authors.initials: F
authors.lastname: Dehdashti
authors.affiliation: From the Department of Medical Imaging, NCSB 1C569 Toronto General Hospital, University of Toronto, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2 (M.A.); Center for Statistical Sciences, Brown University, Providence, RI (F.D., H.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.D.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); Roswell Park Cancer Institute, Buffalo, NY (S.A.); Department of Radiation Oncology, University of Washington Medical Center, Seattle, Wash (W.J.K.); University of Oklahoma Health Sciences Center, Oklahoma City, Okla (R.S.M., K.M.M.); Department of Gynecologic Oncology, Women and Infants Hospital, Providence, RI (P.D.); Seattle Cancer Care Alliance, Seattle, Wash (S.A.K.); School of Medicine, Stony Brook University Health Sciences Center, Stony Brook, NY (M.P.); Department of Gynecologic Oncology, University of Connecticut School of Medicine Hartford HealthCare Cancer Institute at the Hospital of Central Connecticut, New Britain, Conn (X.C.Z.); Department of Obstetrics and Gynecology, Laval University, Quebec City, Quebec, Canada (M.P.); and Department of Gynecologic Oncology, Tulsa Cancer Institute, Tulsa, Okla (M.G.).
authors.forename: Susanna I
authors.initials: SI
authors.lastname: Lee
authors.affiliation: From the Department of Medical Imaging, NCSB 1C569 Toronto General Hospital, University of Toronto, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2 (M.A.); Center for Statistical Sciences, Brown University, Providence, RI (F.D., H.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.D.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); Roswell Park Cancer Institute, Buffalo, NY (S.A.); Department of Radiation Oncology, University of Washington Medical Center, Seattle, Wash (W.J.K.); University of Oklahoma Health Sciences Center, Oklahoma City, Okla (R.S.M., K.M.M.); Department of Gynecologic Oncology, Women and Infants Hospital, Providence, RI (P.D.); Seattle Cancer Care Alliance, Seattle, Wash (S.A.K.); School of Medicine, Stony Brook University Health Sciences Center, Stony Brook, NY (M.P.); Department of Gynecologic Oncology, University of Connecticut School of Medicine Hartford HealthCare Cancer Institute at the Hospital of Central Connecticut, New Britain, Conn (X.C.Z.); Department of Obstetrics and Gynecology, Laval University, Quebec City, Quebec, Canada (M.P.); and Department of Gynecologic Oncology, Tulsa Cancer Institute, Tulsa, Okla (M.G.).
authors.forename: Helga
authors.initials: H
authors.lastname: Marques
authors.affiliation: From the Department of Medical Imaging, NCSB 1C569 Toronto General Hospital, University of Toronto, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2 (M.A.); Center for Statistical Sciences, Brown University, Providence, RI (F.D., H.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.D.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); Roswell Park Cancer Institute, Buffalo, NY (S.A.); Department of Radiation Oncology, University of Washington Medical Center, Seattle, Wash (W.J.K.); University of Oklahoma Health Sciences Center, Oklahoma City, Okla (R.S.M., K.M.M.); Department of Gynecologic Oncology, Women and Infants Hospital, Providence, RI (P.D.); Seattle Cancer Care Alliance, Seattle, Wash (S.A.K.); School of Medicine, Stony Brook University Health Sciences Center, Stony Brook, NY (M.P.); Department of Gynecologic Oncology, University of Connecticut School of Medicine Hartford HealthCare Cancer Institute at the Hospital of Central Connecticut, New Britain, Conn (X.C.Z.); Department of Obstetrics and Gynecology, Laval University, Quebec City, Quebec, Canada (M.P.); and Department of Gynecologic Oncology, Tulsa Cancer Institute, Tulsa, Okla (M.G.).
authors.forename: Shamshad
authors.initials: S
authors.lastname: Ali
authors.affiliation: From the Department of Medical Imaging, NCSB 1C569 Toronto General Hospital, University of Toronto, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2 (M.A.); Center for Statistical Sciences, Brown University, Providence, RI (F.D., H.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.D.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); Roswell Park Cancer Institute, Buffalo, NY (S.A.); Department of Radiation Oncology, University of Washington Medical Center, Seattle, Wash (W.J.K.); University of Oklahoma Health Sciences Center, Oklahoma City, Okla (R.S.M., K.M.M.); Department of Gynecologic Oncology, Women and Infants Hospital, Providence, RI (P.D.); Seattle Cancer Care Alliance, Seattle, Wash (S.A.K.); School of Medicine, Stony Brook University Health Sciences Center, Stony Brook, NY (M.P.); Department of Gynecologic Oncology, University of Connecticut School of Medicine Hartford HealthCare Cancer Institute at the Hospital of Central Connecticut, New Britain, Conn (X.C.Z.); Department of Obstetrics and Gynecology, Laval University, Quebec City, Quebec, Canada (M.P.); and Department of Gynecologic Oncology, Tulsa Cancer Institute, Tulsa, Okla (M.G.).
authors.forename: Wui-Jin
authors.initials: WJ
authors.lastname: Koh
authors.affiliation: From the Department of Medical Imaging, NCSB 1C569 Toronto General Hospital, University of Toronto, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2 (M.A.); Center for Statistical Sciences, Brown University, Providence, RI (F.D., H.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.D.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); Roswell Park Cancer Institute, Buffalo, NY (S.A.); Department of Radiation Oncology, University of Washington Medical Center, Seattle, Wash (W.J.K.); University of Oklahoma Health Sciences Center, Oklahoma City, Okla (R.S.M., K.M.M.); Department of Gynecologic Oncology, Women and Infants Hospital, Providence, RI (P.D.); Seattle Cancer Care Alliance, Seattle, Wash (S.A.K.); School of Medicine, Stony Brook University Health Sciences Center, Stony Brook, NY (M.P.); Department of Gynecologic Oncology, University of Connecticut School of Medicine Hartford HealthCare Cancer Institute at the Hospital of Central Connecticut, New Britain, Conn (X.C.Z.); Department of Obstetrics and Gynecology, Laval University, Quebec City, Quebec, Canada (M.P.); and Department of Gynecologic Oncology, Tulsa Cancer Institute, Tulsa, Okla (M.G.).
authors.forename: Robert S
authors.initials: RS
authors.lastname: Mannel
authors.affiliation: From the Department of Medical Imaging, NCSB 1C569 Toronto General Hospital, University of Toronto, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2 (M.A.); Center for Statistical Sciences, Brown University, Providence, RI (F.D., H.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.D.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); Roswell Park Cancer Institute, Buffalo, NY (S.A.); Department of Radiation Oncology, University of Washington Medical Center, Seattle, Wash (W.J.K.); University of Oklahoma Health Sciences Center, Oklahoma City, Okla (R.S.M., K.M.M.); Department of Gynecologic Oncology, Women and Infants Hospital, Providence, RI (P.D.); Seattle Cancer Care Alliance, Seattle, Wash (S.A.K.); School of Medicine, Stony Brook University Health Sciences Center, Stony Brook, NY (M.P.); Department of Gynecologic Oncology, University of Connecticut School of Medicine Hartford HealthCare Cancer Institute at the Hospital of Central Connecticut, New Britain, Conn (X.C.Z.); Department of Obstetrics and Gynecology, Laval University, Quebec City, Quebec, Canada (M.P.); and Department of Gynecologic Oncology, Tulsa Cancer Institute, Tulsa, Okla (M.G.).
authors.forename: Paul
authors.initials: P
authors.lastname: DiSilvestro
authors.affiliation: From the Department of Medical Imaging, NCSB 1C569 Toronto General Hospital, University of Toronto, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2 (M.A.); Center for Statistical Sciences, Brown University, Providence, RI (F.D., H.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.D.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); Roswell Park Cancer Institute, Buffalo, NY (S.A.); Department of Radiation Oncology, University of Washington Medical Center, Seattle, Wash (W.J.K.); University of Oklahoma Health Sciences Center, Oklahoma City, Okla (R.S.M., K.M.M.); Department of Gynecologic Oncology, Women and Infants Hospital, Providence, RI (P.D.); Seattle Cancer Care Alliance, Seattle, Wash (S.A.K.); School of Medicine, Stony Brook University Health Sciences Center, Stony Brook, NY (M.P.); Department of Gynecologic Oncology, University of Connecticut School of Medicine Hartford HealthCare Cancer Institute at the Hospital of Central Connecticut, New Britain, Conn (X.C.Z.); Department of Obstetrics and Gynecology, Laval University, Quebec City, Quebec, Canada (M.P.); and Department of Gynecologic Oncology, Tulsa Cancer Institute, Tulsa, Okla (M.G.).
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: King
authors.affiliation: From the Department of Medical Imaging, NCSB 1C569 Toronto General Hospital, University of Toronto, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2 (M.A.); Center for Statistical Sciences, Brown University, Providence, RI (F.D., H.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.D.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); Roswell Park Cancer Institute, Buffalo, NY (S.A.); Department of Radiation Oncology, University of Washington Medical Center, Seattle, Wash (W.J.K.); University of Oklahoma Health Sciences Center, Oklahoma City, Okla (R.S.M., K.M.M.); Department of Gynecologic Oncology, Women and Infants Hospital, Providence, RI (P.D.); Seattle Cancer Care Alliance, Seattle, Wash (S.A.K.); School of Medicine, Stony Brook University Health Sciences Center, Stony Brook, NY (M.P.); Department of Gynecologic Oncology, University of Connecticut School of Medicine Hartford HealthCare Cancer Institute at the Hospital of Central Connecticut, New Britain, Conn (X.C.Z.); Department of Obstetrics and Gynecology, Laval University, Quebec City, Quebec, Canada (M.P.); and Department of Gynecologic Oncology, Tulsa Cancer Institute, Tulsa, Okla (M.G.).
authors.forename: Michael
authors.initials: M
authors.lastname: Pearl
authors.affiliation: From the Department of Medical Imaging, NCSB 1C569 Toronto General Hospital, University of Toronto, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2 (M.A.); Center for Statistical Sciences, Brown University, Providence, RI (F.D., H.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.D.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); Roswell Park Cancer Institute, Buffalo, NY (S.A.); Department of Radiation Oncology, University of Washington Medical Center, Seattle, Wash (W.J.K.); University of Oklahoma Health Sciences Center, Oklahoma City, Okla (R.S.M., K.M.M.); Department of Gynecologic Oncology, Women and Infants Hospital, Providence, RI (P.D.); Seattle Cancer Care Alliance, Seattle, Wash (S.A.K.); School of Medicine, Stony Brook University Health Sciences Center, Stony Brook, NY (M.P.); Department of Gynecologic Oncology, University of Connecticut School of Medicine Hartford HealthCare Cancer Institute at the Hospital of Central Connecticut, New Britain, Conn (X.C.Z.); Department of Obstetrics and Gynecology, Laval University, Quebec City, Quebec, Canada (M.P.); and Department of Gynecologic Oncology, Tulsa Cancer Institute, Tulsa, Okla (M.G.).
authors.forename: XunClare
authors.initials: X
authors.lastname: Zhou
authors.affiliation: From the Department of Medical Imaging, NCSB 1C569 Toronto General Hospital, University of Toronto, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2 (M.A.); Center for Statistical Sciences, Brown University, Providence, RI (F.D., H.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.D.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); Roswell Park Cancer Institute, Buffalo, NY (S.A.); Department of Radiation Oncology, University of Washington Medical Center, Seattle, Wash (W.J.K.); University of Oklahoma Health Sciences Center, Oklahoma City, Okla (R.S.M., K.M.M.); Department of Gynecologic Oncology, Women and Infants Hospital, Providence, RI (P.D.); Seattle Cancer Care Alliance, Seattle, Wash (S.A.K.); School of Medicine, Stony Brook University Health Sciences Center, Stony Brook, NY (M.P.); Department of Gynecologic Oncology, University of Connecticut School of Medicine Hartford HealthCare Cancer Institute at the Hospital of Central Connecticut, New Britain, Conn (X.C.Z.); Department of Obstetrics and Gynecology, Laval University, Quebec City, Quebec, Canada (M.P.); and Department of Gynecologic Oncology, Tulsa Cancer Institute, Tulsa, Okla (M.G.).
authors.forename: Marie
authors.initials: M
authors.lastname: Plante
authors.affiliation: From the Department of Medical Imaging, NCSB 1C569 Toronto General Hospital, University of Toronto, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2 (M.A.); Center for Statistical Sciences, Brown University, Providence, RI (F.D., H.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.D.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); Roswell Park Cancer Institute, Buffalo, NY (S.A.); Department of Radiation Oncology, University of Washington Medical Center, Seattle, Wash (W.J.K.); University of Oklahoma Health Sciences Center, Oklahoma City, Okla (R.S.M., K.M.M.); Department of Gynecologic Oncology, Women and Infants Hospital, Providence, RI (P.D.); Seattle Cancer Care Alliance, Seattle, Wash (S.A.K.); School of Medicine, Stony Brook University Health Sciences Center, Stony Brook, NY (M.P.); Department of Gynecologic Oncology, University of Connecticut School of Medicine Hartford HealthCare Cancer Institute at the Hospital of Central Connecticut, New Britain, Conn (X.C.Z.); Department of Obstetrics and Gynecology, Laval University, Quebec City, Quebec, Canada (M.P.); and Department of Gynecologic Oncology, Tulsa Cancer Institute, Tulsa, Okla (M.G.).
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Moxley
authors.affiliation: From the Department of Medical Imaging, NCSB 1C569 Toronto General Hospital, University of Toronto, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2 (M.A.); Center for Statistical Sciences, Brown University, Providence, RI (F.D., H.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.D.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); Roswell Park Cancer Institute, Buffalo, NY (S.A.); Department of Radiation Oncology, University of Washington Medical Center, Seattle, Wash (W.J.K.); University of Oklahoma Health Sciences Center, Oklahoma City, Okla (R.S.M., K.M.M.); Department of Gynecologic Oncology, Women and Infants Hospital, Providence, RI (P.D.); Seattle Cancer Care Alliance, Seattle, Wash (S.A.K.); School of Medicine, Stony Brook University Health Sciences Center, Stony Brook, NY (M.P.); Department of Gynecologic Oncology, University of Connecticut School of Medicine Hartford HealthCare Cancer Institute at the Hospital of Central Connecticut, New Britain, Conn (X.C.Z.); Department of Obstetrics and Gynecology, Laval University, Quebec City, Quebec, Canada (M.P.); and Department of Gynecologic Oncology, Tulsa Cancer Institute, Tulsa, Okla (M.G.).
authors.forename: Michael
authors.initials: M
authors.lastname: Gold
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012186:Retroperitoneal Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D018570:Risk Assessment; D012680:Sensitivity and Specificity
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18