Summary of Clinical 18F-FDG PET/CT Studies on LNM in Endometrial Cancer
| Type | Patients (n) | Median age (y) | FIGO* | Purpose | Results | Conclusions |
| P (27) | 236 | 65 | IA–IVB (79%) | Evaluate value of SUVmax as tool in preoperative work-up of EC, with focus on MI, CI, FIGO, risk stratification, LNM. | PB sens 75%, spec 93%, PPV 60%, NPV 96%, and acc 90% for LNM. SUVmax significantly higher in high-risk EC (high FIGO, MI > 50%, CI vs. no CI, LNM vs. no LNM) than low-risk EC. | Promise for distinguishing high- from low-risk EC and, indirectly, for determining aggressiveness. |
| P (25) | 129 | 67 | IA–IVB (76%) | Determine value of preoperative EC staging and relate imaging parameters to tumor characteristics. | Sens 85%, spec 92%, PPV 65%, NPV 98%, and acc 91% for LNM. SUVmax, MTV, and TLG were significantly related to deep MI, LNM, and high histologic grade. | Preoperative value for LNM detection; parameters relate to tumor aggression and help identify high-risk EC. |
| NA (31) | 106 | 61 | IA–IVB (88%) | Determine clinical value for pelvic LNM detection in EC. | PB sens 97%, spec 69%, PPV 75%, NPV 96%, and acc 93% for LNM. | Preoperative value for LNM detection in EC. |
| P (28) | 76 | 63 | IA–IVB (87%) | Evaluate parameter as predictor of LNM in EC. | Positive correlation: LNM and SUVmax (P = 0.003), MTV (P = 0.007), and TLG (P = 0.003) of PT. PB sens 79%, spec 98%, acc 95%, PPV 92%, and NPV 95% for LNM. | Potential for predicting LMN in EC patients. |
| R (32) | 53 | 58 | IA–IVB (83%) | Determine acc for LNM in EC. | PB sens 50%, spec 94%, PPV 40%, and NPV 96% for LNM. | High spec/NPV usefulness to select patients who may benefit from lymphadenectomy, minimizing surgical complication. |
| P (33) | 46 | 56 | I–IV (63%) | Determine clinical value for pelvic LNM detection in EC. | Sens 50% and spec 92% for detecting pelvic LNM. | Possible acc increase for LMN detection and reduction of false-positive results in preoperative EC patients. |
| P (22) | 40 | 56 | IA–IIIC (92%) | Evaluate acc for LNM detection in EC. | PB sens 50%, spec 86%, and acc 77% for LNM. | Preoperative value for LNM detection. |
| P (34) | 37 | 61 | IA–IVB (83%) | Determine acc for LNM detection in high-risk EC. | PB sens 78%, spec 100%, PPV 100%, NPV 93%, and acc 94% for LNM. | Accurate procedure for preoperative evaluation of pelvic LNM. |
| R (35) | 33 | 54 | NA (94%) | Evaluate diagnostic sens vs. MRI alone in EC patients and correlation between SUVmax and clinicopathologic tumor characteristics. | PB sens 80%, spec 96%, and acc 94% for LNM. Positive correlation between SUVmax of PT and lesion size (P = 0.001). | Diagnostic sens superior to CT or MRI alone in PT and LN detection. |
| R (36) | 30 | 62 | IA–IIIC (90%) | Evaluate acc of 18F-FDG PET/CT and PET/MR in assessment of LNM in EC. | PB sens 100%, spec 96%, and acc 97% for detecting LNM for both PET/MR and PET/CT. However, acc of PET/MR is superior to PET/CT in tumor staging (80% vs. 60%, P < 0.04). | Integrated 18F-FDG PET/MR is superior to PET or MRI alone. Value in PT detection and nodal staging in EC patients. |
| R (37) | 30 | 56 | IA–IVB (63%) | Evaluate clinical usefulness for preoperative evaluation in EC. | PB sens 100% and spec 100% for detecting LNM. | Demonstration of high preoperative diagnostic performance in EC patients. |
| R (38) | 26 | 61 | IA–IVB (53%) | Determine clinical value for primary staging of high-risk EC patients. | PB sens 57%, spec 100%, PPV 100%, NPV 86%, and acc 88% for revealing LN involvement. For detecting distant metastases sens was 100%, spec 96%, PPV 87%, NPV 100%, and acc 97%. | Value in distant metastases detection in abdomen and extraabdominal regions with high diagnostic performance. |
| P (39) | 19 | 66 | IA–IVB (75%) | Determine sens and spec of preoperative 18F-FDG PET in detecting LNM in EC. | PB sens 67% and spec 94% for preoperative prediction of LNM disease in EC. | Preoperative 18F-FDG PET may be helpful with safe omission of lymphadenectomy in selected patients. |
↵* FIGO stage followed by percentage endometrioid.
P = prospective; EC = endometrial cancer; MI = myometrial invasion; CI = cervical invasion; PB = patient-based; sens = sensitivity; spec = specificity; PPV = positive predictive value; NPV = negative predictive value; acc = accuracy; MTV = metabolic tumor volume; TLG = tumor lesion glycolysis; NA = not available; R = retrospective; LN = lymph node.