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Comparison of FDG PET/CT and MRI in lymph node staging of endometrial cancer

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Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

Objective

Endometrial cancer is the most frequent cancer occurring in the female genital tract in the Western countries. Because surgical staging is currently the standard, noninvasive techniques that accurately identify lymph node (LN) metastases would be beneficial by reducing costs and complications. The purpose of our study is to compare the diagnostic accuracy of 2-[18F]fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) with that of magnetic resonance imaging (MRI) for detecting LN metastases in the preoperative staging of endometrial cancer.

Methods

Two hundred eighty-seven consecutive patients with endometrial cancer underwent preoperative PET/CT and MRI for staging. The malignancy criteria for LNs were a short diameter of 1 cm or more by MRI and focally increased 18F-FDG uptake by PET/CT. After evaluating PET/CT and MRI separately, morphologic and functional image findings were compared with the histological findings regarding LN metastasis for all patients. PET/CT and MRI images were classified on the basis of histological findings as true-positive, true-negative, false-positive, or false-negative. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated.

Results

Histologic examination revealed LN metastases in 51 patients (17.8 %). The maximal standardized uptake values (SUVmax) of the primary lesions by PET/CT ranged from 1.4 to 37.7, with a mean value of 9.3, whereas those of the metastatic LNs ranged from 2.0 to 22.5 with a mean of 7.3. On a per-patient basis, node staging resulted in sensitivities of 70.0 % with 18F-FDG PET/CT and 34.0 % with MRI, and specificities of 95.4 % with PET/CT and 95.0 % with MRI. The NPV of PET/CT was 94.3 %, and that of MRI was 87.2 %. On a lesion base analysis, sensitivity of PET/CT was 79.4 % while that of MRI was 51.6 %. In detecting distant metastasis, the sensitivity, specificity, accuracy, PPV, and NPV of PET/CT were 92.9, 98.9, 98.6, 81.3, and 99.6 %, respectively.

Conclusion

Diagnostic performance of FDG PET/CT was better than MRI for detecting metastatic lymph nodes in patients with endometrial cancer both by patient basis and lesion basis analyses. Due to high NPV, FDG PET-CT could aid in selecting candidates for lymphadenectomy.

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Acknowledgments

This study was supported by the National Research Foundation of Korea Grant funded by the Korean Government (No. 2012027176) and National R&D Program for Cancer Control, Ministry of Health & Welfare (1320210).

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Authors and Affiliations

  1. Department of Nuclear Medicine, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Korea

    Hyun Jeong Kim, Arthur Cho, Mijin Yun & Won Jun Kang

  2. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Korea

    Young Tae Kim

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  1. Hyun Jeong Kim
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Correspondence to Won Jun Kang.

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Kim, H.J., Cho, A., Yun, M. et al. Comparison of FDG PET/CT and MRI in lymph node staging of endometrial cancer. Ann Nucl Med 30, 104–113 (2016). https://doi.org/10.1007/s12149-015-1037-8

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  • DOI: https://doi.org/10.1007/s12149-015-1037-8

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