Nordskar Nina Jebens, Hagen Bjørn, Ogarkov Aleksei, Vesterfjell Ellen V, Salvesen Øyvind, Aune Guro
Department of Gynecologic Oncology, Dept. of Obstetrics and Gynecology, St Olav's Hospital, Trondheim University Hospital, 7006, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway.
Department of Gynecologic Oncology, Dept. of Obstetrics and Gynecology, St Olav's Hospital, Trondheim University Hospital, 7006, Trondheim, Norway.
Eur J Obstet Gynecol Reprod Biol. 2021 Apr;259:46-52. doi: 10.1016/j.ejogrb.2021.01.052. Epub 2021 Jan 29.
Improved preoperative evaluation of lymph node status could potentially replace lymphadenectomy in women with endometrial cancer. PET/CT was routinely implemented in the preoperative workup of endometrial cancer at St Olav's University Hospital in 2016. Experience with PET/CT is limited, and there is no consensus about the use of PET/CT in the diagnostic workup of endometrial cancer. The aim of the study was to evaluate the diagnostic accuracy of PET/CT compared to standard CT/MRI in identifying lymph node metastases in endometrial cancer with histologically confirmed lymph node metastases as the standard of reference. We especially wanted to look at PET/CT as a supplement to the sentinel lymph node algorithm in the detection of paraaortic lymph nodes.
A retrospective study included all women undergoing surgery for endometrial cancer from January 2016 through July 2019 at St Olav's University Hospital. Clinical data, results of CT, MRI, and PET/CT, and histopathological results were analyzed.
Among 185 patients included, 27 patients (15 %) had lymph node metastases. 17 (63 %) had pelvic lymph node metastases, one (4 %) had isolated paraaortic lymph node metastases, and 9 (33 %) had lymph node metastases in both the pelvis and the paraaortic region. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PET/CT for the detection of lymph node metastases were 63 %, 98 %, 85 %, 94 %, and 93 %, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CT/MRI were 41 %, 98 %, 73 %, 91 %, and 90 %, respectively (p = 0.07). For the 26 pelvic lymph node metastases, PET/CT had a sensitivity of 58 %, compared to 42 % for CT/MRI (p = 0.22). PET/CT detected all 10 paraaortic lymph node metastases, for a sensitivity of 100 %, compared to 50 % for CT/MRI (p = 0.06).
PET is superior to CT/MRI for detection of lymph node metastases in endometrial cancer, particularly in detecting paraaortic lymph node metastases. The ability of preoperative PET to exclude paraaortic lymph node metastases may strengthen the credibility of the sentinel lymph node algorithm.
改进子宫内膜癌患者淋巴结状态的术前评估可能会取代淋巴结切除术。2016年，圣奥拉夫大学医院在子宫内膜癌的术前检查中常规实施了PET/CT。PET/CT的应用经验有限，对于其在子宫内膜癌诊断检查中的使用尚无共识。本研究的目的是，以组织学确诊的淋巴结转移为参考标准，评估PET/CT与标准CT/MRI相比在识别子宫内膜癌淋巴结转移方面的诊断准确性。我们尤其想研究PET/CT作为前哨淋巴结算法的补充在检测腹主动脉旁淋巴结方面的作用。
一项回顾性研究纳入了2016年1月至2019年7月在圣奥拉夫大学医院接受子宫内膜癌手术的所有女性。分析了临床数据、CT、MRI和PET/CT的结果以及组织病理学结果。
在纳入的185例患者中，27例（15%）有淋巴结转移。17例（63%）有盆腔淋巴结转移，1例（4%）有孤立的腹主动脉旁淋巴结转移，9例（33%）盆腔和腹主动脉旁区域均有淋巴结转移。PET/CT检测淋巴结转移的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为63%、98%、85%、94%和93%。CT/MRI的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为41%、98%、73%、91%和90%（p = 0.07）。对于26例盆腔淋巴结转移，PET/CT的敏感性为58%，而CT/MRI为42%（p = 0.22）。PET/CT检测出了所有10例腹主动脉旁淋巴结转移，敏感性为100%，而CT/MRI为50%（p = 0.06）。
PET在检测子宫内膜癌淋巴结转移方面优于CT/MRI，尤其是在检测腹主动脉旁淋巴结转移方面。术前PET排除腹主动脉旁淋巴结转移的能力可能会增强前哨淋巴结算法的可信度。
