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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.
- Source :
-
Clinical cancer research : an official journal of the American Association for Cancer Research [Clin Cancer Res] 2021 Dec 01; Vol. 27 (23), pp. 6457-6466. Date of Electronic Publication: 2021 Sep 15. - Publication Year :
- 2021
-
Abstract
- Purpose: Preoperative nodal staging is important for planning treatment in cervical cancer and endometrial cancer, but remains challenging. We compare nodal staging accuracy of <superscript>18</superscript> F-ethyl-choline-(FEC)-PET/CT, <superscript>18</superscript> F-fluoro-deoxy-glucose-(FDG)-PET/CT, and diffusion-weighted-MRI (DW-MRI) with conventional morphologic MRI.<br />Experimental Design: A prospective, multicenter observational study of diagnostic accuracy for nodal metastases was undertaken in 5 gyne-oncology centers. FEC-PET/CT, FDG-PET/CT, and DW-MRI were compared with nodal size and morphology on MRI. Reference standard was strictly correlated nodal histology. Eligibility included operable cervical cancer stage ≥ 1B1 or endometrial cancer (grade 3 any stage with myometrial invasion or grade 1-2 stage ≥ II).<br />Results: Among 162 consenting participants, 136 underwent study DW-MRI and FDG-PET/CT and 60 underwent FEC-PET/CT. In 118 patients, 267 nodal regions were strictly correlated at histology (nodal positivity rate, 25%). Sensitivity per patient ( n = 118) for nodal size, morphology, DW-MRI, FDG- and FEC-PET/CT was 40%*, 53%, 53%, 63%*, and 67% for all cases (*, P = 0.016); 10%, 10%, 20%, 30%, and 25% in cervical cancer ( n = 40); 65%, 75%, 70%, 80% and 88% in endometrial cancer ( n = 78). FDG-PET/CT outperformed nodal size ( P = 0.006) and size ratio ( P = 0.04) for per-region sensitivity. False positive rates were all <10%.<br />Conclusions: All imaging techniques had low sensitivity for detection of nodal metastases and cannot replace surgical nodal staging. The performance of FEC-PET/CT was not statistically different from other techniques that are more widely available. FDG-PET/CT had higher sensitivity than size in detecting nodal metastases. False positive rates were low across all methods. The low false positive rate demonstrated by FDG-PET/CT may be helpful in arbitration of challenging surgical planning decisions.<br /> (©2021 The Authors; Published by the American Association for Cancer Research.)
- Subjects :
- Diffusion Magnetic Resonance Imaging
Female
Fluorodeoxyglucose F18
Humans
Magnetic Resonance Imaging methods
Neoplasm Staging
Positron-Emission Tomography methods
Prospective Studies
Radiopharmaceuticals
Tomography, X-Ray Computed methods
Positron Emission Tomography Computed Tomography
Uterine Cervical Neoplasms diagnostic imaging
Uterine Cervical Neoplasms surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1557-3265
- Volume :
- 27
- Issue :
- 23
- Database :
- MEDLINE
- Journal :
- Clinical cancer research : an official journal of the American Association for Cancer Research
- Publication Type :
- Academic Journal
- Accession number :
- 34526364
- Full Text :
- https://doi.org/10.1158/1078-0432.CCR-21-1834