Comparison of FDG PET/CT and MRI in lymph node staging of endometrial cancer

Hyun Jeong Kim, Arthur Cho, Mijin Yun, YoungTae Kim, Won Jun Kang

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objective: Endometrial cancer is the most frequent cancer occurring in the female genital tract in the Western countries. Because surgical staging is currently the standard, noninvasive techniques that accurately identify lymph node (LN) metastases would be beneficial by reducing costs and complications. The purpose of our study is to compare the diagnostic accuracy of 2-[18F]fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) with that of magnetic resonance imaging (MRI) for detecting LN metastases in the preoperative staging of endometrial cancer. Methods: Two hundred eighty-seven consecutive patients with endometrial cancer underwent preoperative PET/CT and MRI for staging. The malignancy criteria for LNs were a short diameter of 1 cm or more by MRI and focally increased 18F-FDG uptake by PET/CT. After evaluating PET/CT and MRI separately, morphologic and functional image findings were compared with the histological findings regarding LN metastasis for all patients. PET/CT and MRI images were classified on the basis of histological findings as true-positive, true-negative, false-positive, or false-negative. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Results: Histologic examination revealed LN metastases in 51 patients (17.8 %). The maximal standardized uptake values (SUVmax) of the primary lesions by PET/CT ranged from 1.4 to 37.7, with a mean value of 9.3, whereas those of the metastatic LNs ranged from 2.0 to 22.5 with a mean of 7.3. On a per-patient basis, node staging resulted in sensitivities of 70.0 % with 18F-FDG PET/CT and 34.0 % with MRI, and specificities of 95.4 % with PET/CT and 95.0 % with MRI. The NPV of PET/CT was 94.3 %, and that of MRI was 87.2 %. On a lesion base analysis, sensitivity of PET/CT was 79.4 % while that of MRI was 51.6 %. In detecting distant metastasis, the sensitivity, specificity, accuracy, PPV, and NPV of PET/CT were 92.9, 98.9, 98.6, 81.3, and 99.6 %, respectively. Conclusion: Diagnostic performance of FDG PET/CT was better than MRI for detecting metastatic lymph nodes in patients with endometrial cancer both by patient basis and lesion basis analyses. Due to high NPV, FDG PET-CT could aid in selecting candidates for lymphadenectomy.

Original languageEnglish
Pages (from-to)104-113
Number of pages10
JournalAnnals of Nuclear Medicine
Volume30
Issue number2
DOIs
Publication statusPublished - 2016 Feb 1

Fingerprint

Endometrial Neoplasms
Lymph Nodes
Magnetic Resonance Imaging
Neoplasm Metastasis
Glucose
Positron Emission Tomography Computed Tomography
Sensitivity and Specificity
Lymph Node Excision
Neoplasms

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

Kim, Hyun Jeong ; Cho, Arthur ; Yun, Mijin ; Kim, YoungTae ; Kang, Won Jun. / Comparison of FDG PET/CT and MRI in lymph node staging of endometrial cancer. In: Annals of Nuclear Medicine. 2016 ; Vol. 30, No. 2. pp. 104-113.
@article{42f8aba7bf924d9c973833283c45e6a3,
title = "Comparison of FDG PET/CT and MRI in lymph node staging of endometrial cancer",
abstract = "Objective: Endometrial cancer is the most frequent cancer occurring in the female genital tract in the Western countries. Because surgical staging is currently the standard, noninvasive techniques that accurately identify lymph node (LN) metastases would be beneficial by reducing costs and complications. The purpose of our study is to compare the diagnostic accuracy of 2-[18F]fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) with that of magnetic resonance imaging (MRI) for detecting LN metastases in the preoperative staging of endometrial cancer. Methods: Two hundred eighty-seven consecutive patients with endometrial cancer underwent preoperative PET/CT and MRI for staging. The malignancy criteria for LNs were a short diameter of 1 cm or more by MRI and focally increased 18F-FDG uptake by PET/CT. After evaluating PET/CT and MRI separately, morphologic and functional image findings were compared with the histological findings regarding LN metastasis for all patients. PET/CT and MRI images were classified on the basis of histological findings as true-positive, true-negative, false-positive, or false-negative. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Results: Histologic examination revealed LN metastases in 51 patients (17.8 {\%}). The maximal standardized uptake values (SUVmax) of the primary lesions by PET/CT ranged from 1.4 to 37.7, with a mean value of 9.3, whereas those of the metastatic LNs ranged from 2.0 to 22.5 with a mean of 7.3. On a per-patient basis, node staging resulted in sensitivities of 70.0 {\%} with 18F-FDG PET/CT and 34.0 {\%} with MRI, and specificities of 95.4 {\%} with PET/CT and 95.0 {\%} with MRI. The NPV of PET/CT was 94.3 {\%}, and that of MRI was 87.2 {\%}. On a lesion base analysis, sensitivity of PET/CT was 79.4 {\%} while that of MRI was 51.6 {\%}. In detecting distant metastasis, the sensitivity, specificity, accuracy, PPV, and NPV of PET/CT were 92.9, 98.9, 98.6, 81.3, and 99.6 {\%}, respectively. Conclusion: Diagnostic performance of FDG PET/CT was better than MRI for detecting metastatic lymph nodes in patients with endometrial cancer both by patient basis and lesion basis analyses. Due to high NPV, FDG PET-CT could aid in selecting candidates for lymphadenectomy.",
author = "Kim, {Hyun Jeong} and Arthur Cho and Mijin Yun and YoungTae Kim and Kang, {Won Jun}",
year = "2016",
month = "2",
day = "1",
doi = "10.1007/s12149-015-1037-8",
language = "English",
volume = "30",
pages = "104--113",
journal = "Annals of Nuclear Medicine",
issn = "0914-7187",
publisher = "Springer Japan",
number = "2",

}

Comparison of FDG PET/CT and MRI in lymph node staging of endometrial cancer. / Kim, Hyun Jeong; Cho, Arthur; Yun, Mijin; Kim, YoungTae; Kang, Won Jun.

In: Annals of Nuclear Medicine, Vol. 30, No. 2, 01.02.2016, p. 104-113.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparison of FDG PET/CT and MRI in lymph node staging of endometrial cancer

AU - Kim, Hyun Jeong

AU - Cho, Arthur

AU - Yun, Mijin

AU - Kim, YoungTae

AU - Kang, Won Jun

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Objective: Endometrial cancer is the most frequent cancer occurring in the female genital tract in the Western countries. Because surgical staging is currently the standard, noninvasive techniques that accurately identify lymph node (LN) metastases would be beneficial by reducing costs and complications. The purpose of our study is to compare the diagnostic accuracy of 2-[18F]fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) with that of magnetic resonance imaging (MRI) for detecting LN metastases in the preoperative staging of endometrial cancer. Methods: Two hundred eighty-seven consecutive patients with endometrial cancer underwent preoperative PET/CT and MRI for staging. The malignancy criteria for LNs were a short diameter of 1 cm or more by MRI and focally increased 18F-FDG uptake by PET/CT. After evaluating PET/CT and MRI separately, morphologic and functional image findings were compared with the histological findings regarding LN metastasis for all patients. PET/CT and MRI images were classified on the basis of histological findings as true-positive, true-negative, false-positive, or false-negative. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Results: Histologic examination revealed LN metastases in 51 patients (17.8 %). The maximal standardized uptake values (SUVmax) of the primary lesions by PET/CT ranged from 1.4 to 37.7, with a mean value of 9.3, whereas those of the metastatic LNs ranged from 2.0 to 22.5 with a mean of 7.3. On a per-patient basis, node staging resulted in sensitivities of 70.0 % with 18F-FDG PET/CT and 34.0 % with MRI, and specificities of 95.4 % with PET/CT and 95.0 % with MRI. The NPV of PET/CT was 94.3 %, and that of MRI was 87.2 %. On a lesion base analysis, sensitivity of PET/CT was 79.4 % while that of MRI was 51.6 %. In detecting distant metastasis, the sensitivity, specificity, accuracy, PPV, and NPV of PET/CT were 92.9, 98.9, 98.6, 81.3, and 99.6 %, respectively. Conclusion: Diagnostic performance of FDG PET/CT was better than MRI for detecting metastatic lymph nodes in patients with endometrial cancer both by patient basis and lesion basis analyses. Due to high NPV, FDG PET-CT could aid in selecting candidates for lymphadenectomy.

AB - Objective: Endometrial cancer is the most frequent cancer occurring in the female genital tract in the Western countries. Because surgical staging is currently the standard, noninvasive techniques that accurately identify lymph node (LN) metastases would be beneficial by reducing costs and complications. The purpose of our study is to compare the diagnostic accuracy of 2-[18F]fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) with that of magnetic resonance imaging (MRI) for detecting LN metastases in the preoperative staging of endometrial cancer. Methods: Two hundred eighty-seven consecutive patients with endometrial cancer underwent preoperative PET/CT and MRI for staging. The malignancy criteria for LNs were a short diameter of 1 cm or more by MRI and focally increased 18F-FDG uptake by PET/CT. After evaluating PET/CT and MRI separately, morphologic and functional image findings were compared with the histological findings regarding LN metastasis for all patients. PET/CT and MRI images were classified on the basis of histological findings as true-positive, true-negative, false-positive, or false-negative. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Results: Histologic examination revealed LN metastases in 51 patients (17.8 %). The maximal standardized uptake values (SUVmax) of the primary lesions by PET/CT ranged from 1.4 to 37.7, with a mean value of 9.3, whereas those of the metastatic LNs ranged from 2.0 to 22.5 with a mean of 7.3. On a per-patient basis, node staging resulted in sensitivities of 70.0 % with 18F-FDG PET/CT and 34.0 % with MRI, and specificities of 95.4 % with PET/CT and 95.0 % with MRI. The NPV of PET/CT was 94.3 %, and that of MRI was 87.2 %. On a lesion base analysis, sensitivity of PET/CT was 79.4 % while that of MRI was 51.6 %. In detecting distant metastasis, the sensitivity, specificity, accuracy, PPV, and NPV of PET/CT were 92.9, 98.9, 98.6, 81.3, and 99.6 %, respectively. Conclusion: Diagnostic performance of FDG PET/CT was better than MRI for detecting metastatic lymph nodes in patients with endometrial cancer both by patient basis and lesion basis analyses. Due to high NPV, FDG PET-CT could aid in selecting candidates for lymphadenectomy.

UR - http://www.scopus.com/inward/record.url?scp=84956914863&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84956914863&partnerID=8YFLogxK

U2 - 10.1007/s12149-015-1037-8

DO - 10.1007/s12149-015-1037-8

M3 - Article

C2 - 26546334

AN - SCOPUS:84956914863

VL - 30

SP - 104

EP - 113

JO - Annals of Nuclear Medicine

JF - Annals of Nuclear Medicine

SN - 0914-7187

IS - 2

ER -