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The Accuracy of Integrated [(18)F] Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography in Detection of Pelvic and Para-aortic Nodal Metastasis in Patients with High Risk Endometrial Cancer.

Gholkar NS, Saha SC, Prasad G, Bhattacharya A, Srinivasan R, Suri V - World J Nucl Med (2014)

Bottom Line: The pelvic nodal findings were analyzed on a patient and nodal chain based criteria.The para-aortic nodal findings were reported separately.Histopathology documented nodal involvement in two patients (10%).

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

ABSTRACT
Lymph nodal (LN) metastasis is the most important prognostic factor in high-risk endometrial cancer. However, the benefit of routine lymphadenectomy in endometrial cancer is controversial. This study was conducted to assess the accuracy of [(18)F] fluorodeoxyglucose-positron emission tomography/computed tomography ([(18)F] FDG-PET/CT) in detection of pelvic and para-aortic nodal metastases in high-risk endometrial cancer. 20 patients with high-risk endometrial carcinoma underwent [(18)F] FDG-PET/CT followed by total abdominal hysterectomy, bilateral salpingo-oophorectomy and systematic pelvic lymphadenectomy with or without para-aortic lymphadenectomy. The findings on histopathology were compared with [(18)F] FDG-PET/CT findings to calculate the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of [(18)F] FDG-PET/CT. The pelvic nodal findings were analyzed on a patient and nodal chain based criteria. The para-aortic nodal findings were reported separately. Histopathology documented nodal involvement in two patients (10%). For detection of pelvic nodes, on a patient based analysis, [(18)F] FDG-PET/CT had a sensitivity of 100%, specificity of 61.11%, PPV of 22.22%, NPV of 100% and accuracy of 65% and on a nodal chain based analysis, [(18)F] FDG-PET/CT had a sensitivity of 100%, specificity of 80%, PPV of 20%, NPV of 100%, and accuracy of 80.95%. For detection of para-aortic nodes, [(18)F] FDG-PET/CT had sensitivity of 100%, specificity of 66.67%, PPV of 20%, NPV of 100%, and accuracy of 69.23%. Although [(18)F] FDG-PET/CT has high sensitivity for detection of LN metastasis in endometrial carcinoma, it had moderate accuracy and high false positivity. However, the high NPV is important in selecting patients in whom lymphadenectomy may be omitted.

No MeSH data available.


Related in: MedlinePlus

A 78-year-old lady with pelvic lymph nodal (LN) metastases. (a) Mild fluorodeoxyglucose (FDG) uptake in left obturator LN. (b) Positron emission tomography/computed tomography image showing intense uptake of FDG in left kidney (white arrow). Intra-operative assessment confirmed no enlargement or metastatic deposits. No histopathological confirmation was done. (c) Left obturator LN showing metastatic deposit
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Figure 2: A 78-year-old lady with pelvic lymph nodal (LN) metastases. (a) Mild fluorodeoxyglucose (FDG) uptake in left obturator LN. (b) Positron emission tomography/computed tomography image showing intense uptake of FDG in left kidney (white arrow). Intra-operative assessment confirmed no enlargement or metastatic deposits. No histopathological confirmation was done. (c) Left obturator LN showing metastatic deposit

Mentions: The postoperative histopathological characteristics of the patients have been shown in Table 2. A total of 180 pelvic and 25 PALNs were resected during surgery. A median of 10 lymph nodes (range: 1-21) were resected in each surgery. Pelvic lymphadenectomy was done in all patients, whereas para-aortic lymphadenectomy/sampling was done in 13 patients. One patient underwent a FNA of the PALN. The median number of PALNs resected was two per surgery (range: 0-4). Of the 20 patients, two patients (10%) had LN metastasis on histopathology. In the node positive patients, all the resected pelvic (10) and para-aortic nodal FNA were positive for one patient [Figure 1], while the other patient had only one PLN (obturator) positive out of seven pelvic nodes resected [Figure 2]. The median number of lymph nodes resected in node positive cases was 8.5 as compared with 10.5 for the node negative cases.


The Accuracy of Integrated [(18)F] Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography in Detection of Pelvic and Para-aortic Nodal Metastasis in Patients with High Risk Endometrial Cancer.

Gholkar NS, Saha SC, Prasad G, Bhattacharya A, Srinivasan R, Suri V - World J Nucl Med (2014)

A 78-year-old lady with pelvic lymph nodal (LN) metastases. (a) Mild fluorodeoxyglucose (FDG) uptake in left obturator LN. (b) Positron emission tomography/computed tomography image showing intense uptake of FDG in left kidney (white arrow). Intra-operative assessment confirmed no enlargement or metastatic deposits. No histopathological confirmation was done. (c) Left obturator LN showing metastatic deposit
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4262875&req=5

Figure 2: A 78-year-old lady with pelvic lymph nodal (LN) metastases. (a) Mild fluorodeoxyglucose (FDG) uptake in left obturator LN. (b) Positron emission tomography/computed tomography image showing intense uptake of FDG in left kidney (white arrow). Intra-operative assessment confirmed no enlargement or metastatic deposits. No histopathological confirmation was done. (c) Left obturator LN showing metastatic deposit
Mentions: The postoperative histopathological characteristics of the patients have been shown in Table 2. A total of 180 pelvic and 25 PALNs were resected during surgery. A median of 10 lymph nodes (range: 1-21) were resected in each surgery. Pelvic lymphadenectomy was done in all patients, whereas para-aortic lymphadenectomy/sampling was done in 13 patients. One patient underwent a FNA of the PALN. The median number of PALNs resected was two per surgery (range: 0-4). Of the 20 patients, two patients (10%) had LN metastasis on histopathology. In the node positive patients, all the resected pelvic (10) and para-aortic nodal FNA were positive for one patient [Figure 1], while the other patient had only one PLN (obturator) positive out of seven pelvic nodes resected [Figure 2]. The median number of lymph nodes resected in node positive cases was 8.5 as compared with 10.5 for the node negative cases.

Bottom Line: The pelvic nodal findings were analyzed on a patient and nodal chain based criteria.The para-aortic nodal findings were reported separately.Histopathology documented nodal involvement in two patients (10%).

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

ABSTRACT
Lymph nodal (LN) metastasis is the most important prognostic factor in high-risk endometrial cancer. However, the benefit of routine lymphadenectomy in endometrial cancer is controversial. This study was conducted to assess the accuracy of [(18)F] fluorodeoxyglucose-positron emission tomography/computed tomography ([(18)F] FDG-PET/CT) in detection of pelvic and para-aortic nodal metastases in high-risk endometrial cancer. 20 patients with high-risk endometrial carcinoma underwent [(18)F] FDG-PET/CT followed by total abdominal hysterectomy, bilateral salpingo-oophorectomy and systematic pelvic lymphadenectomy with or without para-aortic lymphadenectomy. The findings on histopathology were compared with [(18)F] FDG-PET/CT findings to calculate the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of [(18)F] FDG-PET/CT. The pelvic nodal findings were analyzed on a patient and nodal chain based criteria. The para-aortic nodal findings were reported separately. Histopathology documented nodal involvement in two patients (10%). For detection of pelvic nodes, on a patient based analysis, [(18)F] FDG-PET/CT had a sensitivity of 100%, specificity of 61.11%, PPV of 22.22%, NPV of 100% and accuracy of 65% and on a nodal chain based analysis, [(18)F] FDG-PET/CT had a sensitivity of 100%, specificity of 80%, PPV of 20%, NPV of 100%, and accuracy of 80.95%. For detection of para-aortic nodes, [(18)F] FDG-PET/CT had sensitivity of 100%, specificity of 66.67%, PPV of 20%, NPV of 100%, and accuracy of 69.23%. Although [(18)F] FDG-PET/CT has high sensitivity for detection of LN metastasis in endometrial carcinoma, it had moderate accuracy and high false positivity. However, the high NPV is important in selecting patients in whom lymphadenectomy may be omitted.

No MeSH data available.


Related in: MedlinePlus