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Performance of ¹⁸F-FDG PET/CT in Endometrial Cancer

Massachusetts General Hospital Harvard Medical School Boston, MA 02114

WEB—This is a Web exclusive article.

We read with interest the analysis by Kitajima and colleagues [1] of the test performance characteristics of ¹⁸F-FDG PET/CT for detecting nodal involvement by endometrial cancer. After careful evaluation of 1,484 nodes, the authors report that PET/CT shows a node-based sensitivity and specificity of 53.3% and 97.8%, respectively.

The low sensitivity is disappointing given that an accurate imaging technique for assessing nodal status in endometrial cancer patients would be a valuable clinical tool. It would enable a surgeon to plan the extent of lymphadenectomy preoperatively to minimize morbidity and sampling error. For patients who have undergone hysterectomy with incomplete operative staging, such a tool could facilitate non invasive assessment of disease extent and might obviate a second operation.

We note that 35% (14/40) of the patients evaluated in this study had tumors of low grade (grade 1 endometrioid histology). This could explain, in part, the observed low sensitivity. The histologic grade of cancer may correlate with FDG avidity.

It would be helpful to know whether PET/CT is more sensitive in patients with higher-grade tumors. The histologic grade of a cancer is often known from the prehysterectomy endometrial biopsy. Because higher-grade tumors are associated with an increased risk of nodal metastases [2], PET/CT might still prove helpful in planning treatment for the subgroup of endometrial cancer patients at greatest risk for nodal spread.

Can the authors analyze their data to illuminate this issue? Does tumor grade influence the performance characteristics of PET/CT?

References

1. Kitajima K, Murakami K, Yamasaki E, et al. Accuracy of ¹⁸F-FDG PET/CT in detecting pelvic and paraaortic lymph node metastasis in patients with endometrial cancer. AJR2008; 190:1652 –1658[Abstract/Free Full Text]
2. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer: a Gynecologic Oncology Group study. Cancer 1987;60 [8 suppl]:2035 –2041[CrossRef][Medline]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lee, S. I. Articles by Russell, A. H. Search for Related Content PubMed PubMed Citation Articles by Lee, S. I. Articles by Russell, A. H. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?