Abstract
ObjectiveImproved preoperative evaluation of lymph node status could potentially replace lymphadenectomy in women with endometrial cancer. PET/CT was routinely implemented in the preoperative workup of endometrial cancer at St Olav’s University Hospital in 2016. Experience with PET/CT is limited, and there is no consensus about the use of PET/CT in the diagnostic workup of endometrial cancer. The aim of the study was to evaluate the diagnostic accuracy of PET/CT compared to standard CT/MRI in identifying lymph node metastases in endometrial cancer with histologically confirmed lymph node metastases as the standard of reference. We especially wanted to look at PET/CT as a supplement to the sentinel lymph node algorithm in the detection of paraaortic lymph nodes. Study designA retrospective study included all women undergoing surgery for endometrial cancer from January 2016 through July 2019 at St Olav’s University Hospital. Clinical data, results of CT, MRI, and PET/CT, and histopathological results were analyzed. ResultsAmong 185 patients included, 27 patients (15 %) had lymph node metastases. 17 (63 %) had pelvic lymph node metastases, one (4 %) had isolated paraaortic lymph node metastases, and 9 (33 %) had lymph node metastases in both the pelvis and the paraaortic region. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PET/CT for the detection of lymph node metastases were 63 %, 98 %, 85 %, 94 %, and 93 %, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CT/MRI were 41 %, 98 %, 73 %, 91 %, and 90 %, respectively (p = 0.07). For the 26 pelvic lymph node metastases, PET/CT had a sensitivity of 58 %, compared to 42 % for CT/MRI (p = 0.22). PET/CT detected all 10 paraaortic lymph node metastases, for a sensitivity of 100 %, compared to 50 % for CT/MRI (p = 0.06). ConclusionsPET is superior to CT/MRI for detection of lymph node metastases in endometrial cancer, particularly in detecting paraaortic lymph node metastases. The ability of preoperative PET to exclude paraaortic lymph node metastases may strengthen the credibility of the sentinel lymph node algorithm.
Highlights
Primary surgery for apparent early-stage endometrial cancer includes hysterectomy, bilateral salpingo-oophorectomy, and assessment of regional lymph node involvement
The present study indicates a diagnostic value of positron emission tomography (PET)/computed tomography (CT) in the preoperative work-up of endometrial cancer patients, especially in detecting paraaortic lymph node metastases
We found a sensitivity of 63 % and a specificity of 98 % to detect lymph node metastases with PET only in combination with CT (PET/CT)
Summary
Primary surgery for apparent early-stage endometrial cancer includes hysterectomy, bilateral salpingo-oophorectomy, and assessment of regional lymph node involvement. Detecting lymph node metastases in endometrial cancer is important for treatment and prognosis [3,4,5,6]. It is debated if paraaortic nodes should be removed, and whether comprehensive lymphadenectomy improves prognosis, at the cost of increased complications [3,4,7]. Standard preoperative diagnostic tools in endometrial cancer are computed tomography (CT) and magnetic resonance imaging (MRI) [9,10,11,12]. Since 2016, whole body FDG PET/CT has been included in the preoperative diagnostic workup of endometrial cancer in our hospital. Experience and consensus about the use of PET/ CT in the diagnostic workup of endometrial cancer are limited [9]
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