Para-aortic Lymph Node Invasion in High-risk Endometrial Cancer: Performance of 18FDG PET-CT

Abstract

Aim: ¹⁸F-Fluorodeoxyglucose positron-emission tomography integrated with computed tomography (¹⁸FDG PET-CT) is a non-invasive examination that could be helpful for the management of endometrial cancer. This study investigated the performance of ¹⁸FDG PET-CT in assessing para-aortic (PA) lymph-node involvement in high-risk endometrial cancer.

Materials and methods: This was a retrospective, single-center study carried out between 2009 and 2018. The inclusion criteria were high-risk and locally advanced type 1 or 2 endometrial cancer with ¹⁸FDG PET-CT before PA lymphadenectomy.

Results: During the study period, among 142 patients with high-risk endometrial cancer, 35 patients (24.6%) underwent ¹⁸FDG PET-CT followed by PA lymphadenectomy. In 25% of cases, PA lymphadenectomy was not performed due to the discovery of metastasis. ¹⁸FDG PET-CT had a sensitivity of 50%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 75%, accuracy of 80% and an area under the curve of 0.75 for the evaluation of PA involvement.

Conclusion: According to its high specificity in PA lymph-node evaluation, a positive PET scan might allow PA lymphadenectomy to be avoided.

Keywords: Endometrial cancer; PET-CT; lymphadenectomy; para-aortic.