The accuracy of integrated [ 18 F] fluorodeoxyglucose-positron emission tomography/computed tomography in detection of pelvic and para-aortic nodal metastasis in patients with high risk endometrial cancer

Nikhil Gholkar; Subhas Saha; GRV Prasad; Anish Bhattacharya; Radhika Srinivasan; Vanita Suri

doi:10.4103/1450-1147.144817

World Journal of Nuclear Medicine, Table of Contents

CC BY-NC-ND 4.0 · World J Nucl Med 2014; 13(03): 170-177
DOI: 10.4103/1450-1147.144817

Original article

The accuracy of integrated [ ¹⁸ F] fluorodeoxyglucose-positron emission tomography/computed tomography in detection of pelvic and para-aortic nodal metastasis in patients with high risk endometrial cancer

Nikhil Gholkar

Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh

,

Subhas Saha

Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh

,

GRV Prasad

Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh

,

Anish Bhattacharya

Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh

,

Radhika Srinivasan

Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh

,

Vanita Suri

Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh

› Author Affiliations

Abstract

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Lymph nodal (LN) metastasis is the most important prognostic factor in high-risk endometrial cancer. However, the benefit of routine lymphadenectomy in endometrial cancer is controversial. This study was conducted to assess the accuracy of [ ¹⁸ F] fluorodeoxyglucose-positron emission tomography/computed tomography ([ ¹⁸ F] FDG-PET/CT) in detection of pelvic and para-aortic nodal metastases in high-risk endometrial cancer. 20 patients with high-risk endometrial carcinoma underwent [ ¹⁸ F] FDG-PET/CT followed by total abdominal hysterectomy, bilateral salpingo-oophorectomy and systematic pelvic lymphadenectomy with or without para-aortic lymphadenectomy. The findings on histopathology were compared with [ ¹⁸ F] FDG-PET/CT findings to calculate the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of [ ¹⁸ F] FDG-PET/CT. The pelvic nodal findings were analyzed on a patient and nodal chain based criteria. The para-aortic nodal findings were reported separately. Histopathology documented nodal involvement in two patients (10%). For detection of pelvic nodes, on a patient based analysis, [ ¹⁸ F] FDG-PET/CT had a sensitivity of 100%, specificity of 61.11%, PPV of 22.22%, NPV of 100% and accuracy of 65% and on a nodal chain based analysis, [ ¹⁸ F] FDG-PET/CT had a sensitivity of 100%, specificity of 80%, PPV of 20%, NPV of 100%, and accuracy of 80.95%. For detection of para-aortic nodes, [ ¹⁸ F] FDG-PET/CT had sensitivity of 100%, specificity of 66.67%, PPV of 20%, NPV of 100%, and accuracy of 69.23%. Although [ ¹⁸ F] FDG-PET/CT has high sensitivity for detection of LN metastasis in endometrial carcinoma, it had moderate accuracy and high false positivity. However, the high NPV is important in selecting patients in whom lymphadenectomy may be omitted.

Keywords

[ ¹⁸ F] Fluorodeoxyglucose-positron emission tomography/computed tomography - endometrial cancer - high risk - lymphadenectomy - preoperative imaging

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