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Accuracy of integrated FDG-PET/contrast-enhanced CT in detecting pelvic and paraaortic lymph node metastasis in patients with uterine cancer

  • Nuclear Medicine
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Abstract

The purpose is to evaluate the accuracy of integrated 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography ((CT) with intravenous contrast medium in detecting pelvic and paraaortic lymph node metastasis in patients with uterine cancer, with surgical and histopathological findings used as the reference standard. Forty-five patients with endometrial or uterine cervical cancer underwent radical hysterectomy, including pelvic lymphadenectomy with or without paraaortic lymphadenectomy, after PET/CT. PET/CT findings were interpreted by two experienced radiologists in consensus. The criterion for malignancy on PET/CT images was increased tracer uptake by the lymph node, independent of node size. The overall node-based sensitivity, specificity, PPV, NPV and accuracy of PET/CT for detecting nodal metastases were 51.1% (23/45), 99.8% (1,927/1,931), 85.2% (23/27), 98.9% (1,927/1,949) and 98.7% (1,950/1,976), respectively. The sensitivity for detecting metastatic lesions 4 mm or less in short-axis diameter was 12.5% (2/16), that for between 5 and 9 mm was 66.7% (16/24), and that for 10 mm or larger was 100.0% (5/5). The overall patient-based sensitivity, specificity, positive predictive value ((PPV), negative predictive value (NPV), and accuracy were 50% (6/12), 90.9% (30/33), 66.7% (6/9), 83.3% (30/36) and 80.0% (36/45), respectively. Integrated FDG-PET/contrast-enhanced CT is superior to conventional imaging, but only moderately sensitive in predicting lymph node metastasis preoperatively in patients with uterine cancer.

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Acknowledgments

We thank the gynecologists, especially Ichio Fukasawa and Noriyuki Inaba, for recruiting patients to undergo PET/CT. We also thank Kennichi Kobayashi, Kouichi Asano, Kazufumi Suzuki, and Kaoru Ishida for their excellent technical assistance and generous support.

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Authors and Affiliations

  1. Department of Radiology, Dokkyo University School of Medicine, 880 Kita-kobayashi, Mibu, Shimotuka-gun, Tochigi, 321-0293, Japan

    Kazuhiro Kitajima & Yasushi Kaji

  2. PET Center, Dokkyo Medical University Hospital, Mibu, Japan

    Kazuhiro Kitajima, Koji Murakami & Erena Yamasaki

  3. Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan

    Kazuhiro Kitajima & Kazuro Sugimura

Authors
  1. Kazuhiro Kitajima
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  2. Koji Murakami
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  3. Erena Yamasaki
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  4. Yasushi Kaji
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  5. Kazuro Sugimura
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Correspondence to Kazuhiro Kitajima.

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Kitajima, K., Murakami, K., Yamasaki, E. et al. Accuracy of integrated FDG-PET/contrast-enhanced CT in detecting pelvic and paraaortic lymph node metastasis in patients with uterine cancer. Eur Radiol 19, 1529–1536 (2009). https://doi.org/10.1007/s00330-008-1271-8

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  • DOI: https://doi.org/10.1007/s00330-008-1271-8

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