Accuracy of18F-FDG PET/CT in detecting pelvic and paraaortic lymph node metastasis in patients with endometrial cancer

Kazuhiro Kitajima, Koji Murakami, Erena Yamasaki, Ichio Fukasawa, Noriyuki Inaba, Yasushi Kaji, Kazuro Sugimura

Research output: Contribution to journalArticle

118 Citations (Scopus)

Abstract

OBJECTIVE. The objective of our study was to evaluate the accuracy of integrated PET and CT (PET/CT) using 18F-FDG in detecting pelvic and paraaortic lymph node metastasis in patients with endometrial cancer, using surgical and histopathologic findings as the reference standard. SUBJECTS AND METHODS. Forty patients with clinical stages IA to IIIC underwent radical hysterectomy, including pelvic lymphadenectomy with or without paraaortic lymphadenectomy, after FDG PET/CT. Lymphadenectomy involved removing all visible lymph nodes in the surgical fields. PET/CT findings were interpreted by two experienced radiologists in consensus and compared with histopathologic results. The criterion for malignancy on PET/CT images was increased radiotracer uptake by a lymph node independent of node size. RESULTS. In total, 62 pathologically positive nodes were found in 10 patients and 60 of 62 dissected metastatic nodes were identified on the CT component. The overall node-based sensitivity, specificity, and accuracy of PET/CT for detecting nodal metastases were 53.3% (32/60), 99.6% (1,419/1,424), and 97.8% (1,451/1,484), respectively. The sensitivity for detecting metastatic lesions 4 mm or less in diameter was 16.7% (4/24), that for lesions between 5 and 9 mm was 66.7% (14/21), and that for lesions 10 mm or larger was 93.3% (14/15). The overall patient-based sensitivity, specificity, and accuracy were 50% (5/10), 86.7% (26/30), and 77.5% (31/40), respectively. CONCLUSION. Integrated FDG PET/CT is superior to conventional imaging techniques, but it is only moderately sensitive in predicting lymph node metastasis preoperatively in patients with endometrial cancer. Even PET/CT should not replace lymphadenectomy.

Original languageEnglish
Pages (from-to)1652-1658
Number of pages7
JournalAmerican Journal of Roentgenology
Volume190
Issue number6
DOIs
Publication statusPublished - 2008 Jun
Externally publishedYes

Fingerprint

Endometrial Neoplasms
Lymph Node Excision
Lymph Nodes
Neoplasm Metastasis
Sensitivity and Specificity
Fluorodeoxyglucose F18
Hysterectomy
Neoplasms

Keywords

  • Endometrial cancer
  • FDG PET/CT
  • Lymph node metastasis
  • Oncologic imaging
  • PET/CT
  • Women's imaging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology
  • Medicine(all)

Cite this

Accuracy of18F-FDG PET/CT in detecting pelvic and paraaortic lymph node metastasis in patients with endometrial cancer. / Kitajima, Kazuhiro; Murakami, Koji; Yamasaki, Erena; Fukasawa, Ichio; Inaba, Noriyuki; Kaji, Yasushi; Sugimura, Kazuro.

In: American Journal of Roentgenology, Vol. 190, No. 6, 06.2008, p. 1652-1658.

Research output: Contribution to journalArticle

Kitajima, K, Murakami, K, Yamasaki, E, Fukasawa, I, Inaba, N, Kaji, Y & Sugimura, K 2008, 'Accuracy of18F-FDG PET/CT in detecting pelvic and paraaortic lymph node metastasis in patients with endometrial cancer', American Journal of Roentgenology, vol. 190, no. 6, pp. 1652-1658. https://doi.org/10.2214/AJR.07.3372
Kitajima, Kazuhiro ; Murakami, Koji ; Yamasaki, Erena ; Fukasawa, Ichio ; Inaba, Noriyuki ; Kaji, Yasushi ; Sugimura, Kazuro. / Accuracy of18F-FDG PET/CT in detecting pelvic and paraaortic lymph node metastasis in patients with endometrial cancer. In: American Journal of Roentgenology. 2008 ; Vol. 190, No. 6. pp. 1652-1658.
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abstract = "OBJECTIVE. The objective of our study was to evaluate the accuracy of integrated PET and CT (PET/CT) using 18F-FDG in detecting pelvic and paraaortic lymph node metastasis in patients with endometrial cancer, using surgical and histopathologic findings as the reference standard. SUBJECTS AND METHODS. Forty patients with clinical stages IA to IIIC underwent radical hysterectomy, including pelvic lymphadenectomy with or without paraaortic lymphadenectomy, after FDG PET/CT. Lymphadenectomy involved removing all visible lymph nodes in the surgical fields. PET/CT findings were interpreted by two experienced radiologists in consensus and compared with histopathologic results. The criterion for malignancy on PET/CT images was increased radiotracer uptake by a lymph node independent of node size. RESULTS. In total, 62 pathologically positive nodes were found in 10 patients and 60 of 62 dissected metastatic nodes were identified on the CT component. The overall node-based sensitivity, specificity, and accuracy of PET/CT for detecting nodal metastases were 53.3{\%} (32/60), 99.6{\%} (1,419/1,424), and 97.8{\%} (1,451/1,484), respectively. The sensitivity for detecting metastatic lesions 4 mm or less in diameter was 16.7{\%} (4/24), that for lesions between 5 and 9 mm was 66.7{\%} (14/21), and that for lesions 10 mm or larger was 93.3{\%} (14/15). The overall patient-based sensitivity, specificity, and accuracy were 50{\%} (5/10), 86.7{\%} (26/30), and 77.5{\%} (31/40), respectively. CONCLUSION. Integrated FDG PET/CT is superior to conventional imaging techniques, but it is only moderately sensitive in predicting lymph node metastasis preoperatively in patients with endometrial cancer. Even PET/CT should not replace lymphadenectomy.",
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AU - Yamasaki, Erena

AU - Fukasawa, Ichio

AU - Inaba, Noriyuki

AU - Kaji, Yasushi

AU - Sugimura, Kazuro

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N2 - OBJECTIVE. The objective of our study was to evaluate the accuracy of integrated PET and CT (PET/CT) using 18F-FDG in detecting pelvic and paraaortic lymph node metastasis in patients with endometrial cancer, using surgical and histopathologic findings as the reference standard. SUBJECTS AND METHODS. Forty patients with clinical stages IA to IIIC underwent radical hysterectomy, including pelvic lymphadenectomy with or without paraaortic lymphadenectomy, after FDG PET/CT. Lymphadenectomy involved removing all visible lymph nodes in the surgical fields. PET/CT findings were interpreted by two experienced radiologists in consensus and compared with histopathologic results. The criterion for malignancy on PET/CT images was increased radiotracer uptake by a lymph node independent of node size. RESULTS. In total, 62 pathologically positive nodes were found in 10 patients and 60 of 62 dissected metastatic nodes were identified on the CT component. The overall node-based sensitivity, specificity, and accuracy of PET/CT for detecting nodal metastases were 53.3% (32/60), 99.6% (1,419/1,424), and 97.8% (1,451/1,484), respectively. The sensitivity for detecting metastatic lesions 4 mm or less in diameter was 16.7% (4/24), that for lesions between 5 and 9 mm was 66.7% (14/21), and that for lesions 10 mm or larger was 93.3% (14/15). The overall patient-based sensitivity, specificity, and accuracy were 50% (5/10), 86.7% (26/30), and 77.5% (31/40), respectively. CONCLUSION. Integrated FDG PET/CT is superior to conventional imaging techniques, but it is only moderately sensitive in predicting lymph node metastasis preoperatively in patients with endometrial cancer. Even PET/CT should not replace lymphadenectomy.

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KW - FDG PET/CT

KW - Lymph node metastasis

KW - Oncologic imaging

KW - PET/CT

KW - Women's imaging

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