Abstract
BackgroundPreoperative accurate assessment of endometrial cancer can assist in the planning of additional surgical options, and in predicting the prognosis. The aim of the present study was to evaluate the diagnostic potential of non-contrast PET/MRI with 18F-fluorodeoxyglucose (18F-FDG) for assessment in preoperative staging of endometrial cancer.MethodsThirty-six patients with biopsy-proven endometrial cancer underwent preoperative 18F-FDG PET/MRI, contrast-enhanced CT (ceCT) and pelvic dynamic contrast-enhanced MRI (ceMRI) for initial staging. The diagnostic performance of 18F-FDG PET/MRI and ceMRI for assessing the extent of the primary tumor (T stage), and 18F-FDG PET/MRI and ceCT for assessing nodal (N stage) and distant (M stage) metastasis, was evaluated by two experienced readers. Histopathological and follow-up imaging results were used as the gold standard. The McNemar test was employed for statistical analysis.ResultsAccuracy for T status was 77.8 and 75.0% for 18F-FDG PET/MRI and ceMRI, respectively. Patient-based accuracy for detecting regional nodal and distant metastasis was 91.3 and 81.8% for 18F-FDG PET/MRI, and 87.0 and 81.8% for ceCT. None of these parameters was statistically significant (p > 0.05). Lesion-based sensitivity, specificity and accuracy for detecting regional nodal metastasis were 100, 96.9 and 97.0% for 18F-FDG PET/MRI, and 14.3, 97.6 and 93.3% for ceCT; sensitivity was statistically significant (p < 0.05).ConclusionsNon-contrast 18F-FDG PET/MRI, which combines the individual advantages of PET and MRI, offers a high diagnostic value equivalent to that of ceMRI for assessment of the primary tumor, and equivalent to that of ceCT for the assessment of nodal and distant metastatic staging, in patients with endometrial cancer. These findings suggest that 18F-FDG PET/MRI might provide an alternative diagnostic strategy to conventional imaging modalities in the preoperative staging of endometrial cancer.
Highlights
Endometrial cancer is the most common gynecological malignancy in developed countries, and its incidence continues to increase
For the detection of lymph node and distant metastasis, 18F-FDG Positron emission tomography (PET)/computed tomography (CT) could be more useful than conventional imaging such as CT or magnetic resonance imaging (MRI) [5]; limited data are available for assessment of local disease [6]
36 patients who had undergone 18F-FDG PET/MRI, contrast-enhanced CT (ceCT), and pelvic dynamic contrast-enhanced MRI (ceMRI) for initial staging based on the Japanese Imaging Guidelines of the Japan Radiological Society were included in the present study [11, 12]
Summary
Endometrial cancer is the most common gynecological malignancy in developed countries, and its incidence continues to increase. Tsuyoshi et al Cancer Imaging (2020) 20:75 as pelvic or para-aortic lymphadenectomy or radical hysterectomy, and in predicting the prognosis [2] In these evaluations of local disease, magnetic resonance imaging (MRI) offers better diagnostic performance than transvaginal ultrasonography (US) and could be considered the reference standard [3]. For the detection of lymph node and distant metastasis, 18F-FDG PET/computed tomography (CT) could be more useful than conventional imaging such as CT or MRI [5]; limited data are available for assessment of local disease [6]. Preoperative accurate assessment of endometrial cancer can assist in the planning of additional surgical options, and in predicting the prognosis. The aim of the present study was to evaluate the diagnostic potential of non-contrast PET/MRI with 18F-fluorodeoxyglucose (18F-FDG) for assessment in preoperative staging of endometrial cancer
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