Preoperative PET/CT does not accurately detect extrauterine disease in patients with newly diagnosed high‐risk endometrial cancer: A prospective study

Abstract

BACKGROUND:The identification of extrauterine disease is critical to the management of patients with high-risk endometrial cancer.The purpose of the current study was to determine the accuracy of preoperative positron emission tomography (PET)/computed to mography (CT) in the detection of extrauterine disease. METHODS: Women with high-risk endometrial cancer were enrolled prospectively and underwent preoperative PET/CT followed by surgery, including sentinel lymph node biopsy and lymphadenectomy. Primary tumor factors on PET/CT were correlated with lymph node pathology. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the detection of lymphadenopathy and peritoneal disease by PET/CT. RESULTS: A total of 112 patients were enrolled and underwent PET/CT between April 2013 and May 2016, 108 of whom were evaluable. On PET/CT, 21 patients (19.4%) were found to have extrauterine disease, 18 (17%) had positive lymph nodes, and 8 (7%) had peritoneal disease. A total of 108 patients underwent surgery, 103 of whom (95%) underwent lymphadenectomy. The sensitivity of PET/CT to detect positive lymph nodes was 45.8%, with a specificity of 91.1%, positive predictive value of 61.1%, and negative predictive value of 84.7%. The false-negative rate was 54.2%. There was no difference in primary tumor characteristics on imaging noted between patients with positive and negative lymph nodes. The sensitivity of PET/CT to detect peritoneal disease was 37.5%, with a specificity of 97.8%, positive predictive value of 75%, and negative predictive value of 90.0%. The false-negative rate was 62.5%. CONCLUSIONS: Preoperative PET/CT did not reliably predict the presence of extrauterine disease in women with high-risk endometrial cancer. Given the high false-negative rates, PET/CT should not be used in the preoperative treatment planning of these patients.

Preoperative Assessment for High‐Risk Endometrial Cancer by Developing anMRI‐ and Clinical‐Based Radiomics Nomogram: A Multicenter Study

“…13,14,[27][28][29] Positron emission tomography / computed tomography (PET/CT) did not reliably predict the high-risk EC for high false-negative rates. 30 However, the radiomics developed in this study might be helpful in identifying the risk factors of EC preoperatively, being consistent with preliminary studies using MRI-based texture analysis of small sample size. 31,32 In the optimization process of the LASSO method for radiomics feature selection, the T 2 WI features had the highest weight in the radiomics signature, suggesting an important role of conventional sequence-based features in a prediction model.…”

“…Previous studies indicated a low specificity and accuracy of routine MRI in evaluating these risk factors 13,14,27–29 . Positron emission tomography / computed tomography (PET/CT) did not reliably predict the high‐risk EC for high false‐negative rates 30 . However, the radiomics developed in this study might be helpful in identifying the risk factors of EC preoperatively, being consistent with preliminary studies using MRI‐based texture analysis of small sample size 31,32 …”

Combinative evaluation of primary tumor and lymph nodes to predict pelvic lymphatic metastasis in cervical cancer: an integrated PET-IVIM MRI study

“…In this study, PET was also significantly better than MR in the diagnosis of lymph nodes. But we found a large number of PET false-negative cases, which accords with the findings of endometrial cancer and non-small cell lung cancer studies [36,37]. Identifying PET false-negative cases has always been a clinical challenge.…”

The Evaluation of Preoperative ¹⁸F-FDG PET/CT in Patients with Endometrial Cancer and the Correlation Between PET Parameters and Postoperative Pathology Results

“…In the literature, the relationship between the SUV max values of the primary tumor and presence of LNM is unclear. Husby et al ( 11 ) detected a considerable difference between the SUV max values of these two groups, whereas Stewart et al ( 12 ) found no differences in primary tumor characteristics on PET/CT imaging between patients with positive and negative lymph nodes.…”