FDG-PET/CT and Para-Aortic Staging in Endometrial Cancer. A French Multicentric Study.

Camille Sallée,Jérémie Belghiti,Antoine Tardieu,Sébastien Gouy,Frédéric Guyon,Tristan Gauthier,Eric Lambaudie,François Margueritte,Maxime Legros,Jacques Monteil,Pierre Collinet

doi:10.3390/jcm10081746

Abstract

Background: FDG-PET/CT is a noninvasive examination that could be helpful for the management of endometrial cancer. The aim of this study was to evaluate the performance of FDG-PET/CT in assessing para-aortic lymph-node involvement in high-risk endometrial cancer. Methods: We performed a retrospective multicenter study including all patients who had a high-risk endometrial cancer with a preoperative FDG-PET/CT and a para-aortic lymphadenectomy (PAL) between 2009 and 2019. The main objective was to evaluate the overall performance of FDG-PET/CT. The secondary objectives were to evaluate its performances according to the histological type and according to FDG-PET/CT date (before or after hysterectomy), and to compare its overall performance with that of the MRI scan. Results: We included 200 patients from six different centers. After the false positive FDG-PET/CT was reread by nuclear physicians, FDG-PET/CT had a sensitivity of 61.8%, a specificity of 89.7%, a positive predictive value of 69.4%, a negative predictive value of 86.1%, and an AUC of 0.76. There were no statistically significant differences in the performances according to either histological type and or FDG-PET/CT date. The sensitivity of FDG-PET/CT was better than that of MRI (p < 0.01), but the specificity was not (p = 0.82). Conclusion: Currently, FDG-PET/CT alone cannot replace PAL for the lymph node evaluation of high-risk endometrial cancers. It seems essential to reread it in multidisciplinary meetings before validating the therapeutic management of patients, particularly in the case of isolated para-aortic involvement.

Highlights

The PORTEC-3 study found a gain in recurrence-free survival for stage III endometrial cancers when chemotherapy is added to radiotherapy (69.3% vs. 58.0%, p = 0.032) justifying knowledge of lymph node status [2]
From January 2009 to December 2019, 200 patients were treated for high-risk endometrial cancer and benefited from Para-aortic lymphadenectomy (PAL) with preoperative FDG-PET/CT in six French centers (Figure 1)
The results found in our study are comparable to those found in the literature, presented in Table 4 synthesizing the different series that focused on the performance of the FDG-PET/CT scan in para-aortic evaluation

Summary

Introduction

It is currently necessary to know the lymph node status and the FIGO stage in order to establish the most appropriate therapeutic strategy. The PORTEC-3 study found a gain in recurrence-free survival for stage III endometrial cancers when chemotherapy is added to radiotherapy (69.3% vs 58.0%, p = 0.032) justifying knowledge of lymph node status [2]. Knowledge of the pelvic and paraaortic lymph node status influences the therapeutic decision through the indication or not of more or less extensive radiotherapy and systemic treatment [6]. Lymphadenectomy is currently the “gold standard” for the evaluation of lymph node involvement in endometrial cancer. FDG-PET/CT is a noninvasive examination that could be helpful for the management of endometrial cancer. The aim of this study was to evaluate the performance of FDG-PET/CT in assessing para-aortic lymph-node involvement in high-risk endometrial cancer

Methods

Results

Discussion

Conclusion