Aim: 18 F-Fluorodeoxyglucose positron-emission tomography integrated with computed tomography ( 18 FDG PET-CT) is a non-invasive examination that could be helpful for the management of endometrial cancer. This study investigated the performance of 18 FDG PET-CT in assessing para-aortic (PA) lymph-node involvement in high-risk endometrial cancer. Materials and Methods: This was a retrospective, single-center study carried out between 2009 and 2018. The inclusion criteria were high-risk and locally advanced type 1 or 2 endometrial cancer with 18 FDG PET-CT before PA lymphadenectomy. Results: During the study period, among 142 patients with high-risk endometrial cancer, 35 patients (24.6%) underwent 18 FDG PET-CT followed by PA lymphadenectomy. In 25% of cases, PA lymphadenectomy was not performed due to the discovery of metastasis. 18 FDG PET-CT had a sensitivity of 50%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 75%, accuracy of 80% and an area under the curve of 0.75 for the evaluation of PA involvement. Conclusion: According to its high specificity in PA lymph-node evaluation, a positive PET scan might allow PA lymphadenectomy to be avoided.Endometrial cancer is the fourth most frequent cancer in women, with more than 8,000 cases per year in France (1). A knowledge of lymph-node status and International Federation of Gynecology and Obstetrics (FIGO) stage is necessary to establish the most appropriate treatment strategy. The risk of lymph-node involvement is strongly correlated with the characteristics of the tumor, and depends on its histological type, grade, the degree of local extension (myometrium and cervical stroma), and the presence of lymphovascular space invasion (2). Since the European Society for Medical Oncology (ESMO) congress of 2009 (3) and the publication of the French National Institute of Cancer (INCA) recommendations in 2010 (4), para-aortic lymphadenectomy (PAL) has been recommended for stage I tumors of histological type 1 (endometrioid adenocarcinoma) with a high risk of recurrence (stage IB and grade 3, or with the presence of lymphovascular space invasion, regardless of grade), for tumors of stage II and above, and for histological type 2 tumors (clear-cell carcinoma, papillary serous carcinoma, and carcinosarcoma) of all stages.PAL is a surgical procedure associated with non-negligible morbidity, particularly in elderly patients with associated comorbid conditions (5). Its therapeutic impact on survival is a matter of debate (6). Knowledge of pelvic and paraaortic (PA) lymph-node status guides therapeutic decisions, determining whether there are indications for more or less extensive radiotherapy and systemic treatment (7). The PORTEC-3 study showed that adjuvant chemotherapy, in addition to radiotherapy, was beneficial in stage III high-risk endometrial cancer (8).18 F-Fluorodeoxyglucose positron-emission tomography integrated with computed tomography ( 18 FDG PET-CT) is a non-invasive examination that can modify the management of endometr...
This paper seeks to examine the evolution of determinants under scrutiny by academics publishing on performance of ethnic companies in Organisation for Economic Co-operation and Development (OECD) countries. Using the systematic literature review method, we first provide a descriptive analysis of articles gathered, and then make an in-depth examination of the determinants focused on. A database of 40 papers published between 2002 and 2011 was collected the topic was precise enough to yield only a few articles from a wide range of journals. We provide a systemized summary of the current status of this body of work, examine areas where research is lacking, and explain why further study of the role of cultural and ethical values as determinants of ethnic entrepreneurship is critical.
Background: FDG-PET/CT is a noninvasive examination that could be helpful for the management of endometrial cancer. The aim of this study was to evaluate the performance of FDG-PET/CT in assessing para-aortic lymph-node involvement in high-risk endometrial cancer. Methods: We performed a retrospective multicenter study including all patients who had a high-risk endometrial cancer with a preoperative FDG-PET/CT and a para-aortic lymphadenectomy (PAL) between 2009 and 2019. The main objective was to evaluate the overall performance of FDG-PET/CT. The secondary objectives were to evaluate its performances according to the histological type and according to FDG-PET/CT date (before or after hysterectomy), and to compare its overall performance with that of the MRI scan. Results: We included 200 patients from six different centers. After the false positive FDG-PET/CT was reread by nuclear physicians, FDG-PET/CT had a sensitivity of 61.8%, a specificity of 89.7%, a positive predictive value of 69.4%, a negative predictive value of 86.1%, and an AUC of 0.76. There were no statistically significant differences in the performances according to either histological type and or FDG-PET/CT date. The sensitivity of FDG-PET/CT was better than that of MRI (p < 0.01), but the specificity was not (p = 0.82). Conclusion: Currently, FDG-PET/CT alone cannot replace PAL for the lymph node evaluation of high-risk endometrial cancers. It seems essential to reread it in multidisciplinary meetings before validating the therapeutic management of patients, particularly in the case of isolated para-aortic involvement.
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