Diagnostic accuracy of FEC-PET/CT, FDG-PET/CT, and diffusion-weighted MRI in detection of nodal metastases in surgically treated endometrial and cervical carcinoma

Abstract

Purpose: Preoperative nodal staging is important for planning correlated at histology (nodal positivity rate, 25%). Sensitivity treatment in cervical cancer and endometrial cancer, but remains per patient (n ¼ 118) for nodal size, morphology, DW-MRI, challenging. We compare nodal staging accuracy of 18F-ethyl-FDG- and FEC-PET/CT was 40%∗, 53%, 53%, 63%∗, and 67% choline-(FEC)-PET/CT, 18F-fluoro-deoxy-glucose-(FDG)-PET/ for all cases (∗, P ¼ 0.016); 10%, 10%, 20%, 30%, and 25% in cervical CT, and diffusion-weighted-MRI (DW-MRI) with conventional cancer (n ¼ 40); 65%, 75%, 70%, 80% and 88% in endometrial morphologic MRI. cancer (n ¼ 78). FDG-PET/CT outperformed nodal size (P ¼ 0.006) Experimental Design: A prospective, multicenter observational and size ratio (P ¼ 0.04) for per-region sensitivity. False positive study of diagnostic accuracy for nodal metastases was undertaken in 5 rates were all <10%. gyne-oncology centers. FEC-PET/CT, FDG-PET/CT, and DW-MRI Conclusions: All imaging techniques had low sensitivity for were compared with nodal size and morphology on MRI. Reference detection of nodal metastases and cannot replace surgical nodal standard was strictly correlated nodal histology. Eligibility included staging. The performance of FEC-PET/CT was not statistically operable cervical cancer stage ≥ 1B1 or endometrial cancer (grade 3 different from other techniques that are more widely available. any stage with myometrial invasion or grade 1–2 stage ≥ II). FDG-PET/CT had higher sensitivity than size in detecting nodal Results: Among 162 consenting participants, 136 under-metastases. False positive rates were low across all methods. The went study DW-MRI and FDG-PET/CT and 60 underwent low false positive rate demonstrated by FDG-PET/CT may be FEC-PET/CT. In 118 patients, 267 nodal regions were strictly helpful in arbitration of challenging surgical planning decisions.