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Accuracy of 18F-FDG PET/CT in Detecting Pelvic and Paraaortic Lymph Node Metastasis in Patients with Endometrial Cancer

Kazuhiro Kitajima1,2,3, Koji Murakami2, Erena Yamasaki2, Ichio Fukasawa4, Noriyuki Inaba4, Yasushi Kaji1 and Kazuro Sugimura3

1 Department of Radiology, Dokkyo University School of Medicine, 880 Kita-kobayashi, Mibu, Shimotuka-gun, Tochigi 321-0293, Japan.
2 PET Center, Dokkyo Medical University Hospital, Mibu, Japan.
3 Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan.
4 Department of Obstetrics and Gynecology, Dokkyo University School of Medicine, Mibu, Japan.


Figure 1
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  		Fig. 1A —50-year-old woman with pelvic lymph node metastasis (true-positive case). 18F-FDG PET scan shows area of intense FDG uptake in left pelvic region (arrow). Owing to absence of precise anatomic landmarks, high accumulation of radiotracer depicted cannot be unequivocally attributed to lymph node metastasis.

 

Figure 2
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  		Fig. 1B —50-year-old woman with pelvic lymph node metastasis (true-positive case). Unenhanced CT scan shows lymph node (arrow) of 5 mm in short-axis diameter in left external iliac chain.

 

Figure 3
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  		Fig. 1C —50-year-old woman with pelvic lymph node metastasis (true-positive case). PET/CT image shows that abnormal FDG uptake corresponds to external iliac lymph node (arrow) seen in B, suggesting presence of nodal cancer spread. Histopathologic specimen findings confirmed extensive lymph node involvement by cancer.

 

Figure 4
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  		Fig. 2A —53-year-old woman with paraaortic lymph node metastasis (true-positive case). 18F-FDG PET scan shows area of intense FDG uptake in right and left paraaortic regions (arrows).

 

Figure 5
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  		Fig. 2B —53-year-old woman with paraaortic lymph node metastasis (true-positive case). Unenhanced CT scan shows three lymph nodes of 3, 4, and 4 mm in short-axis diameter in right region of vena cava (straight arrow) and two lymph nodes of 4 and 8 mm in short-axis diameter in left region of aorta (curved arrow).

 

Figure 6
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  		Fig. 2C —53-year-old woman with paraaortic lymph node metastasis (true-positive case). PET/CT image shows that abnormal FDG uptake corresponds to five paraaortic lymph nodes (arrows) seen in B, suggesting presence of nodal cancer spread. Histopathologic specimen findings confirmed extensive lymph node involvement by cancer in five nodes.

 

Figure 7
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  		Fig. 3A —58-year-old woman with paraaortic lymph node metastasis (falsenegative case). 18F-FDG PET scan shows no intense FDG uptake in left paraaortic region.

 

Figure 8
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  		Fig. 3B —58-year-old woman with paraaortic lymph node metastasis (falsenegative case). Unenhanced CT scan shows four lymph nodes of 2, 2, 3, and 4 mm in short-axis diameter in left paraaortic region (arrow).

 

Figure 9
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  		Fig. 3C —58-year-old woman with paraaortic lymph node metastasis (falsenegative case). PET/CT image shows no abnormal FDG uptake corresponds to paraaortic lymph nodes (arrow) seen in B, suggesting absence of nodal cancer spread. However, histopathologic specimen findings confirmed extensive lymph node involvement by cancer in all four nodes.

 

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