Additional Value of FDG-PET/MRI Complementary to Sentinel Lymphonodectomy for Minimal Invasive Lymph Node Staging in Patients with Endometrial Cancer: A Prospective Study.
Matthias Weissinger, Lidia Bala, Sara Yvonne Brucker, Stefan Kommoss, Sascha Hoffmann, Ferdinand Seith, Konstantin Nikolaou, Christian la Fougère, Christina Barbara Walter, Helmut Dittmann
Author Information
Matthias Weissinger: Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany. ORCID
Lidia Bala: Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, 72076 Tuebingen, Germany.
Sara Yvonne Brucker: Department of Women's Health, University Hospital Tuebingen, 72076 Tuebingen, Germany. ORCID
Stefan Kommoss: Department of Women's Health, University Hospital Tuebingen, 72076 Tuebingen, Germany.
Sascha Hoffmann: Department of Women's Health, University Hospital Tuebingen, 72076 Tuebingen, Germany. ORCID
Ferdinand Seith: Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany. ORCID
Konstantin Nikolaou: Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany. ORCID
Christian la Fougère: Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, 72076 Tuebingen, Germany. ORCID
Christina Barbara Walter: Department of Women's Health, University Hospital Tuebingen, 72076 Tuebingen, Germany. ORCID
Helmut Dittmann: Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, 72076 Tuebingen, Germany. ORCID
BACKGROUND: Lymph node metastases (LNM) are rare in early-stage Endometrial Cancer, but a diagnostic systematic lymphadenectomy (LNE) is often performed to achieve reliable N-staging. Therefore, this prospective study aimed to evaluate the benefit of [18F]-Fluorodeoxyglucose (FDG) PET/MRI complementary to SPECT/CT guided sentinel lymphonodectomy (SLNE) for a less invasive N-staging Methods: 79 patients underwent a whole-body FDG-PET/MRI, SLN mapping with Tc-Nanocolloid SPECT/CT and indocyanine green (ICG) fluoroscopy followed by LNE which served as ground truth. RESULTS: FDG-PET/MRI was highly specific in N-staging (97.2%) but revealed limited sensitivity (66.7%) due to missed micrometastases. In contrast, bilateral SLN mapping failed more often in patients with macrometastases. The combination of SLN mapping and FDG-PET/MRI increased the sensitivity from 66.7% to 77.8%. Additional SLN labeling with dye (ICG) revealed a complete SLN mapping in 80% (8/10) of patients with failed or incomplete SLN detection in SPECT/CT, reducing the need for diagnostic systematic LNE up to 87%. FDG-PET/MRI detected para-aortic LNM in three out of four cases and a liver metastasis. CONCLUSIONS: The combination of FDG-PET/MRI and SLNE can reduce the need for diagnostic systematic LNE by up to 87%. PET/MRI complements the SLN technique particularly in the detection of para-aortic LNM and occasional distant metastases.
