Tailoring systematic lymphadenectomy in high-risk clinical early stage endometrial cancer: The role of 18F-FDG PET/CT

Crivellaro, Cinzia; Signorelli, Mauro; Guerra, Luca; Ponti, Elena De; Pirovano, Cecilia; Fruscio, Robert; Elisei, Federica; Montanelli, Luca; Buda, Alessandro; Messa, Cristina

doi:10.1016/j.ygyno.2013.05.011

Cited by 60 publications

(54 citation statements)

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“…A recent update from the Memorial Sloan Kettering Cancer Center after 10 y of experience with sentinel lymph node mapping in uterine cancer concluded that prospective studies are needed to validate the use of sentinel lymph node mapping in early-stage endometrial cancer (27). Interestingly, the negative predictive value in the present study was very high (97%-98%), confirming the 95% reported by Criverallo et al (13) and the 96% reported by Antonsen et al (22). Thus, the combined high specificity and high negative predictive value confirm that 18 F-FDG PET/CT is presently the most promising imaging method to exclude lymph node metastases and thus help avoid potentially harmful lymphadenectomy for staging.…”

Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 79%

“…The sensitivity is within the higher range compared with most previous studies (60%-83%) (12)(13)(14)(15)22), whereas the specificity is within the lower range compared with previous studies (93%-100%) (12)(13)(14)(15)22). Accuracy seems quite similar to that reported recently (90%-95%) (12,13,22). Our ability to compare staging using 18 F-FDG PET/CT with that using sentinel lymph node procedures is currently limited, as the true performance in endometrial carcinomas is not well established because the studies have been small and the techniques applied have often varied (26).…”

Section: Discussionmentioning

confidence: 43%

“…18 F-FDG PET/CT combines morphologic and physiologic techniques and is the preferred imaging method for various cancers (11). Although several studies have suggested that 18 F-FDG PET/CT can be beneficial preoperatively in endometrial cancer patients (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), its clinical role in risk stratification of such patients is not well defined. Furthermore, the value of various quantitative tumor parameters and the corresponding optimal cutoffs for the prediction of tumor stage and prognosis are largely unexplored.…”

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confidence: 99%

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Metabolic Tumor Volume on ¹⁸F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients

et al. 2015

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Our objective was to prospectively explore the diagnostic value of 18 F-FDG PET/CT for preoperative staging in endometrial carcinomas and to investigate whether 18 F-FDG PET-specific quantitative tumor parameters reflect clinical and histologic characteristics. Methods: Preoperative 18 F-FDG PET/CT was prospectively performed on 129 consecutive endometrial carcinoma patients. Two physicians who did not know the clinical findings or staging results independently reviewed the images, assessing primary tumor, cervical stroma involvement and metastatic spread, and determining maximum and mean standardized uptake value (SUV max and SUV mean , respectively) for tumor, metabolic tumor volume (MTV), and total lesion glycolysis (TLG). All parameters were analyzed in relation to histomorphologic and clinical tumor characteristics. Receiver-operatingcharacteristic curves for identification of deep myometrial invasion and lymph node metastases were generated, and MTV cutoffs for predicting deep myometrial invasion and lymph node metastases were calculated. Results: The sensitivity, specificity, and accuracy of 18 F-FDG PET/CT for the detection of lymph node metastases were 77%-85%, 91%-96%, and 89%-93%, respectively. SUV max , SUV mean , MTV, and TLG were significantly related to deep myometrial invasion, presence of lymph node metastases, and high histologic grade (P , 0.015 for all) and independently predicted deep myometrial invasion (P , 0.015) and lymph node metastases (P , 0.025) after adjustment for preoperative histologic risk (based on subtype and grade) in endometrial biopsies. Optimal cutoffs for MTV in predicting deep myometrial invasion (20 mL) and the presence of lymph node metastases (30 mL) yielded odds ratios of 7.8 (P , 0.001) and 16.5 (P 5 0.001), respectively. Conclusion: 18 F-FDG PET/CT represents a clinically valuable tool for preoperatively evaluating the presence of lymph node metastases in endometrial carcinoma patients. Applying MTV cutoffs for the prediction of deep myometrial invasion and lymph node metastases may increase diagnostic accuracy and aid preoperative identification of high-risk patients, enabling restriction of lymphadenectomy for patients with a low risk of aggressive disease.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 43%

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confidence: 99%

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Metabolic Tumor Volume on ¹⁸F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients

et al. 2015

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“…Additionally, they found that SUV max was significantly higher in patients with high FIGO stage, myometrial invasion, and cervical invasion. Furthermore, Crivellaro et al (28) found strong association between the presence of LNM and metabolic tumor volume in endometrial cancer. Recently, we demonstrated that the preoperative metabolic tumor volume cutoff value of 30 mL yielded sensitivity and specificity of 85% and 76% for LNM, respectively, suggesting that the metabolic tumor volume is a promising marker for LNM (25).…”

Section: Discussionmentioning

confidence: 97%

High Diagnostic Value of ¹⁸F-FDG PET/CT in Endometrial Cancer: Systematic Review and Meta-Analysis of the Literature

et al. 2016

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The aim of this study was to evaluate the diagnostic performance of 18 F-FDG PET/CT for the preoperative assessment of lymph node metastases (LNM) in endometrial cancer patients and for the assessment of endometrial cancer recurrence (ECR) after primary surgical treatment. Methods: A comprehensive search was performed on Pubmed/MEDLINE databases for studies reporting the diagnostic performance of 18 F-FDG PET/CT for assessment of LNM and ECR published up to August 15, 2015. Twenty-one studies (13 for LNM and 8 for ECR) were included in the systematic review and meta-analysis. Pooled estimates of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of the 18 F-FDG PET/CT were calculated along with 95% confidence intervals (CIs). A summary receiver-operating-characteristics curve (SROC) was constructed, and the area under the SROC curve (AUC) was determined along with Q* index. Results: The overall pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and AUC (with 95% CI) of 18 F-FDG PET/CT for detection of LNM were 0.72 (95% CI, 0.63-0.80), 0.94 (95% CI, 0.93-0.96), 10.9 (95% CI, 7.9-15.1), 0.36 (95% CI, 0.27-0.48), 39.7 (95% CI, 21.4-73.6), and 0.94 (95% CI, 0.85-0.99), respectively, whereas the corresponding numbers for detection of ECR were 0.95 (95% CI, 0.91-0.98), 0.91 (95% CI, 0.86-0.94), 8.8 (95% CI, 0.08 (95% CI, 171.7 (95% CI,3), and 0.97 (95% CI, 0.95-0.98), respectively. The overall diagnostic accuracy (Q* index) in LNM and ECR were 0.88 and 0.93, respectively. Conclusion: 18 F-FDG PET/CT has an excellent diagnostic performance for detecting LNM preoperatively and disease recurrence postoperatively in endometrial cancer patients.Key Words: endometrial cancer; FDG; PET and CT J Nucl Med 2016; 57:879-885 DOI: 10.2967/jnumed.115.170597 Endomet rial cancer is the most common gynecologic malignancy in the developed countries (1). The prognosis is traditionally determined by clinical and histopathologic factors-that is, age, histologic type, grade, and stage of disease including assessment of cervical invasion, depth of myometrial invasion, lymph node spread, and distant metastases (2-4). The 5-y overall survival rate is generally favorable, around 80%. However, pelvic lymph node metastases (LNM) represents the most common site for extrauterine disease at primary treatment, and the 5-y survival rate is around 50% for this patient subgroup (5).Currently, the final staging of endometrial cancer is based on histopathologic findings at primary surgery, which includes abdominal exploration, peritoneal cytology washing from the pelvis, hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy in selected patients presumed to have a high risk of disease spread (6-8). Routine systemic pelvic lymphadenectomy for earlystage endometrial cancer disease, although not well defined as a surgical technique, improves detection of LNM, but the procedure showed no survival benefit in 2 randomized clinic...

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Imaging in the Management of Gynecologic Cancers

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et al. 2019

Practical Guides in Radiation Oncology

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Tailoring systematic lymphadenectomy in high-risk clinical early stage endometrial cancer: The role of 18F-FDG PET/CT

Cited by 60 publications

References 47 publications

Metabolic Tumor Volume on ¹⁸F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients

Metabolic Tumor Volume on ¹⁸F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients

High Diagnostic Value of ¹⁸F-FDG PET/CT in Endometrial Cancer: Systematic Review and Meta-Analysis of the Literature

Imaging in the Management of Gynecologic Cancers

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Tailoring systematic lymphadenectomy in high-risk clinical early stage endometrial cancer: The role of 18F-FDG PET/CT

Cited by 60 publications

References 47 publications

Metabolic Tumor Volume on 18F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients

Metabolic Tumor Volume on 18F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients

High Diagnostic Value of 18F-FDG PET/CT in Endometrial Cancer: Systematic Review and Meta-Analysis of the Literature

Imaging in the Management of Gynecologic Cancers

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Metabolic Tumor Volume on ¹⁸F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients

Metabolic Tumor Volume on ¹⁸F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients

High Diagnostic Value of ¹⁸F-FDG PET/CT in Endometrial Cancer: Systematic Review and Meta-Analysis of the Literature