FDG-PET/CT and Para-Aortic Staging in Endometrial Cancer. A French Multicentric Study.
Camille Sall��e, Fran��ois Margueritte, S��bastien Gouy, Antoine Tardieu, J��r��mie Belghiti, Eric Lambaudie, Pierre Collinet, Fr��d��ric Guyon, Maxime Legros, Jacques Monteil, Tristan Gauthier
Author Information
Camille Sall��e: Department of Gynaecology and Obstetrics, CHU Limoges, 87042 Limoges, France. ORCID
Fran��ois Margueritte: Department of Gynaecology and Obstetrics, CHU Limoges, 87042 Limoges, France. ORCID
S��bastien Gouy: Department of Surgery, Gustave Roussy Comprehensive Cancer Center, 94800 Villejuif, France.
Antoine Tardieu: Department of Gynaecology and Obstetrics, CHU Limoges, 87042 Limoges, France.
J��r��mie Belghiti: Department of Gynecologic and Breast Surgery and Oncology, Piti��-Salp��tri��re, AP-HP, 75013 Paris, France.
Eric Lambaudie: Institut Paoli Calmettes and CRCM, 13009 Marseille, France.
Pierre Collinet: Gynaecological Surgery Unit, Jeanne de Flandre Hospital, University Hospital of Lille, 59000 Lille, France.
Fr��d��ric Guyon: Institut Bergoni��, 229, 33000 Bordeaux, France.
Maxime Legros: Department of Gynaecology and Obstetrics, CHU Limoges, 87042 Limoges, France.
Jacques Monteil: Nuclear Medicine Department, Limoges University Hospital, 87042 Limoges, France.
Tristan Gauthier: Department of Gynaecology and Obstetrics, CHU Limoges, 87042 Limoges, France. ORCID
BACKGROUND: FDG-PET/CT is a noninvasive examination that could be helpful for the management of endometrial cancer. The aim of this study was to evaluate the performance of FDG-PET/CT in assessing para-aortic lymph-node involvement in high-risk endometrial cancer. METHODS: We performed a retrospective multicenter study including all patients who had a high-risk endometrial cancer with a preoperative FDG-PET/CT and a para-aortic lymphadenectomy (PAL) between 2009 and 2019. The main objective was to evaluate the overall performance of FDG-PET/CT. The secondary objectives were to evaluate its performances according to the histological type and according to FDG-PET/CT date (before or after hysterectomy), and to compare its overall performance with that of the MRI scan. RESULTS: We included 200 patients from six different centers. After the false positive FDG-PET/CT was reread by nuclear physicians, FDG-PET/CT had a sensitivity of 61.8%, a specificity of 89.7%, a positive predictive value of 69.4%, a negative predictive value of 86.1%, and an AUC of 0.76. There were no statistically significant differences in the performances according to either histological type and or FDG-PET/CT date. The sensitivity of FDG-PET/CT was better than that of MRI ( < 0.01), but the specificity was not ( = 0.82). CONCLUSION: Currently, FDG-PET/CT alone cannot replace PAL for the lymph node evaluation of high-risk endometrial cancers. It seems essential to reread it in multidisciplinary meetings before validating the therapeutic management of patients, particularly in the case of isolated para-aortic involvement.
