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Radiology. 2017 May;283(2):450-459. doi: 10.1148/radiol.2016160200. Epub 2017 Jan 3.

Utility of PET/CT to Evaluate Retroperitoneal Lymph Node Metastasis in High-Risk Endometrial Cancer: Results of ACRIN 6671/GOG 0233 Trial.

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From the Department of Medical Imaging, NCSB 1C569 Toronto General Hospital, University of Toronto, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2 (M.A.); Center for Statistical Sciences, Brown University, Providence, RI (F.D., H.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (F.D.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (S.I.L.); Roswell Park Cancer Institute, Buffalo, NY (S.A.); Department of Radiation Oncology, University of Washington Medical Center, Seattle, Wash (W.J.K.); University of Oklahoma Health Sciences Center, Oklahoma City, Okla (R.S.M., K.M.M.); Department of Gynecologic Oncology, Women and Infants Hospital, Providence, RI (P.D.); Seattle Cancer Care Alliance, Seattle, Wash (S.A.K.); School of Medicine, Stony Brook University Health Sciences Center, Stony Brook, NY (M.P.); Department of Gynecologic Oncology, University of Connecticut School of Medicine Hartford HealthCare Cancer Institute at the Hospital of Central Connecticut, New Britain, Conn (X.C.Z.); Department of Obstetrics and Gynecology, Laval University, Quebec City, Quebec, Canada (M.P.); and Department of Gynecologic Oncology, Tulsa Cancer Institute, Tulsa, Okla (M.G.).


Purpose To assess the diagnostic accuracy of fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) combined with diagnostic contrast material-enhanced computed tomography (CT) in detecting lymph node (LN) metastasis in high-risk endometrial cancer. Materials and Methods This prospective multicenter HIPAA-compliant study had institutional review board approval, and all participants gave written informed consent. Data were accrued between January 2010 and June 2013. Patients underwent PET/CT and pelvic and abdominal lymphadenectomy. Two hundred seven of 215 enrolled patients had PET/CT and pathologic examination results for the abdomen and pelvis. Mean patient age was 62.7 years ± 9.6 (standard deviation). Data in all 23 patients with a positive abdominal examination and in 26 randomly selected patients with a negative abdominal examination were used for this central reader study. Seven independent blinded readers reviewed diagnostic CT and PET/CT results in different sessions 1 month apart. Accuracy was calculated at the participant level, correlating abdominal (right and left para-aortic and common iliac) and pelvic (right and left external iliac and obturator) LN regions with pathologic results, respecting laterality. Reader-average sensitivities, specificities, and areas under the receiver operating characteristic curve (AUCs) of PET/CT and diagnostic CT were compared. Power calculation was for sensitivity and specificity in the abdomen. Results Sensitivities of PET/CT versus diagnostic CT for the detection of LN metastasis were 0.65 (95% confidence interval [CI]: 0.57, 0.72) versus 0.50 (95% CI: 0.43, 0.58) (P = .01) in the abdomen and 0.65 (95% CI: 0.57, 0.72) versus 0.48 (95% CI: 0.41, 0.56) (P = .004) in the pelvis. Corresponding specificities were 0.88 (95% CI: 0.83, 0.92) versus 0.93 (95% CI: 0.89, 0.96) (P = .11) and 0.93 (95% CI: 0.86, 0.96) versus 0.89 (95% CI: 0.82, 0.94) (P = .27), and AUCs were 0.78 (95% CI: 0.66, 0.89) versus 0.74 (95% CI: 0.63, 0.86) (P = .39) and 0.82 (95% CI: 0.71, 0.92) versus 0.73 (95% CI: 0.63, 0.84) (P = .02). Conclusion FDG PET/CT has satisfactory diagnostic accuracy in the detection of abdominal LN metastasis in high-risk endometrial cancer. Compared with diagnostic CT alone, addition of PET to diagnostic CT significantly increased sensitivity in both the abdomen and pelvis while maintaining high specificity. © RSNA, 2017 Online supplemental material is available for this article.

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