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Role of Positron Emission Tomography/Computed Tomography in Preoperative Assessment of Carcinoma Endometrium—a Retrospective Analysis

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Abstract

PET/CT has made significant inroads into routine oncological practice in recent times. In our study, we aim to determine its value in preoperative assessment of endometrial carcinoma. A retrospective study between January 2011 and March 2016 was conducted; we included all cases of carcinoma endometrium with a preoperative PET/CT scan. PET/CT images were analyzed and correlated with histological findings after surgical staging. A total of 46 cases were analyzed, mean age was 59.8 years, BMI 30.8 kg/m2, and most common histology endometrioid type (69.5%). We correlated PET/CT findings with histopathology as reference standard. PET/CT had a sensitivity of 40%, moderate specificity (75%) and accuracy (71.7%), good NPV (91.2%), but poor PPV (16.7%) for lymph node involvement. A total of 10 (21.7%) cases were detected to have distant metabolically active lesions on PET/CT, seven out of these were positive for malignancy. And 90% of them were either non-endometrioid type or grade two and higher. We found that SUV of primary tumor was significantly higher in patients with deep myometrial invasion (p = 0.018), and high-risk histological type of tumor (p = 0.022), though not statistically significant when lymph nodal involvement (p = 0.9), cervical involvement (p = 0.56), or histological grade (p = 0.84) were considered. Sensitivity and specificity of PET/CT in staging endometrial cancer is not high enough to reliably tailor lymphadenectomy. Although SUV of the primary tumor was significantly higher in patients with deep myometrial invasion and high-risk histological type, it’s usefulness in classifying patients into predefined risk groups seems to be limited. However, it is useful in detecting distant metastasis especially in high-grade and non-endometrioid type of tumors. Thus, implementation of PET/CT as a surrogate for surgical staging of endometrial cancer remains enigmatic and is open to further research.

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Authors and Affiliations

  1. Department of Gynaecological Oncology, HCG hospital, Bengaluru, India

    Rohini Kulkarni

  2. Department of Gynaecological Oncology, HCG Hospital, Bengaluru, India

    Rohini Kulkarni, Rani Akhil Bhat & Vibhawari Dhakharia

  3. Radiodiagnosis and Nuclear Medicine, HCG hospital, Bengaluru, India

    Kumar Kallur

  4. Department of Onco - Pathology, HCG hospital, Bengaluru, India

    Aparna Gangoli

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  1. Rohini Kulkarni
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Correspondence to Rohini Kulkarni.

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Kulkarni, R., Bhat, R.A., Dhakharia, V. et al. Role of Positron Emission Tomography/Computed Tomography in Preoperative Assessment of Carcinoma Endometrium—a Retrospective Analysis. Indian J Surg Oncol 10, 225–231 (2019). https://doi.org/10.1007/s13193-018-0826-7

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  • DOI: https://doi.org/10.1007/s13193-018-0826-7

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