The value of PET/CT in determining lymph node metastasis of endometrial cancer

In our study, the role of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) in determining lymph node metastasis of endometrial cancer was evaluated.

The present retrospectively registered study included 80 patients with endometrial cancer who underwent PET/CT in preoperative period. The patients underwent total hysterectomy with bilateral salpingo-oophorectomy and lymph node dissection. Lymph node status was evaluated in histopathologic examination and PET/CT imaging and, the results were compared.

There were 80 patients (mean age 62 years) in the present study. Lymph node metastasis was detected in five patients, whereas 75 patients had no lymph node metastasis. A total of 1,471 lymph nodes were examined histopathologically, revealing benign findings in 1,433 (pelvic = 1018, paraaortic = 415) and malignant findings in 38 (pelvic = 28, paraaortic = 10) lymph nodes. The accuracy, sensitivity and specificity of PET/CT in determining lymph node metastasis was 95%, 80% and 96% in patient-based evaluation, and 97.4%, 78.9% and 98.6% in lymph node-based evaluation, respectively. The detection sensitivity of PET/CT was 0%, 81.4% and 100% in metastatic lymph nodes with a short diameter of ≤ 4 mm, 5-9 mm and ≥ 10 mm, respectively. PET/CT could detect 73.3% of metastatic lymph nodes that had < 10 mm short diameter.

PET/CT is useful method in detecting lymph node metastasis especially that are disregarded by CT or MR in endometrial cancer. Although PET/CT doesn't fully replace the surgical staging, its utilization in preoperative period may guide surgical procedure.