Preoperative PET/CT does not accurately detect extrauterine disease in patients with newly diagnosed high-risk endometrial cancer: A prospective study

Cancer. 2019 Oct 1;125(19):3347-3353. doi: 10.1002/cncr.32329. Epub 2019 Jun 21.

Abstract

Background: The identification of extrauterine disease is critical to the management of patients with high-risk endometrial cancer. The purpose of the current study was to determine the accuracy of preoperative positron emission tomography (PET)/computed tomography (CT) in the detection of extrauterine disease.

Methods: Women with high-risk endometrial cancer were enrolled prospectively and underwent preoperative PET/CT followed by surgery, including sentinel lymph node biopsy and lymphadenectomy. Primary tumor factors on PET/CT were correlated with lymph node pathology. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the detection of lymphadenopathy and peritoneal disease by PET/CT.

Results: A total of 112 patients were enrolled and underwent PET/CT between April 2013 and May 2016, 108 of whom were evaluable. On PET/CT, 21 patients (19.4%) were found to have extrauterine disease, 18 (17%) had positive lymph nodes, and 8 (7%) had peritoneal disease. A total of 108 patients underwent surgery, 103 of whom (95%) underwent lymphadenectomy. The sensitivity of PET/CT to detect positive lymph nodes was 45.8%, with a specificity of 91.1%, positive predictive value of 61.1%, and negative predictive value of 84.7%. The false-negative rate was 54.2%. There was no difference in primary tumor characteristics on imaging noted between patients with positive and negative lymph nodes. The sensitivity of PET/CT to detect peritoneal disease was 37.5%, with a specificity of 97.8%, positive predictive value of 75%, and negative predictive value of 90.0%. The false-negative rate was 62.5%.

Conclusions: Preoperative PET/CT did not reliably predict the presence of extrauterine disease in women with high-risk endometrial cancer. Given the high false-negative rates, PET/CT should not be used in the preoperative treatment planning of these patients.

Keywords: endometrial cancer; extrauterine disease; lymph nodes; lymphadenectomy; peritoneal disease; preoperative positron emission tomography/computed tomography (PET/CT).

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Endometrial Neoplasms / pathology*
  • Endometrial Neoplasms / surgery
  • Endometrium / pathology
  • Endometrium / surgery
  • False Negative Reactions
  • Feasibility Studies
  • Female
  • Fluorodeoxyglucose F18 / administration & dosage
  • Humans
  • Hysterectomy
  • Lymphatic Metastasis / diagnostic imaging*
  • Middle Aged
  • Peritoneal Neoplasms / diagnostic imaging*
  • Peritoneal Neoplasms / secondary
  • Positron Emission Tomography Computed Tomography / statistics & numerical data*
  • Predictive Value of Tests
  • Preoperative Care / statistics & numerical data*
  • Prospective Studies
  • Radiopharmaceuticals
  • Reproducibility of Results
  • Salpingo-oophorectomy
  • Sentinel Lymph Node / diagnostic imaging
  • Sentinel Lymph Node / pathology
  • Sentinel Lymph Node Biopsy

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18