4.7 Article

Diagnostic Accuracy of FEC-PET/CT, FDG-PET/CT, and Diffusion-Weighted MRI in Detection of Nodal Metastases in Surgically Treated Endometrial and Cervical Carcinoma

Journal

CLINICAL CANCER RESEARCH
Volume 27, Issue 23, Pages 6457-6466

Publisher

AMER ASSOC CANCER RESEARCH
DOI: 10.1158/1078-0432.CCR-21-1834

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Funding

  1. Biomarkers and Imaging Discovery and Development (BIDD) Project
  2. Cancer Research UK
  3. National Institute of Health Research Imperial Biomedical Centre
  4. Imperial Cancer Research UK Centre
  5. Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
  6. National Institute for Health Research Biomedical Research Centre at Guy's & St Thomas' Hospitals and King's College London
  7. Engineering and Physical Sciences Research Council
  8. Medical Research Council
  9. Department of Health [C1519/A16463]
  10. National Institute for Health Research (NIHR) Biomedical Research Centre at The Royal Marsden NHS Foundation Trust
  11. Institute of Cancer Research, London
  12. Cancer Research UK [C444/A15953]
  13. University College London
  14. University College London Hospital Biomedical Research Centre
  15. Alliance Medical sites for PET/CT research slots at Lancashire Teaching HospitalsNHS Foundation Trust
  16. King's College London/University College London Comprehensive Cancer Imaging Centre - Cancer Research UK

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The study compared FEC-PET/CT, FDG-PET/CT, and DW-MRI with conventional MRI for nodal staging accuracy in cervical and endometrial cancer patients. All imaging techniques had low sensitivity for detecting nodal metastases and cannot replace surgical nodal staging. FDG-PET/CT showed higher sensitivity in detecting nodal metastases compared to nodal size.
Purpose: Preoperative nodal staging is important for planning treatment in cervical cancer and endometrial cancer, but remains challenging. We compare nodal staging accuracy of F-18-ethyl-choline-(FEC)-PET/CT, F-18-fluoro-deoxy-glucose-(FDG)-PET/ CT, and diffusion-weighted-MRI (DW-MRI) with conventional morphologic MRI. Experimental Design: A prospective, multicenter observational study of diagnostic accuracy for nodal metastases was undertaken in 5 gyne-oncology centers. FEC-PET/CT, FDG-PET/CT, and DW-MRI were compared with nodal size and morphology on MRI. Reference standard was strictly correlated nodal histology. Eligibility included operable cervical cancer stage >= 1B1 or endometrial cancer (grade 3 any stage with myometrial invasion or grade 1-2 stage >= II). Results: Among 162 consenting participants, 136 under-went study DW-MRI and FDG-PET/CT and 60 underwent FEC-PET/CT. In 118 patients, 267 nodal regions were strictly correlated at histology (nodal positivity rate, 25%). Sensitivity per patient (n = 118) for nodal size, morphology, DW-MRI, FDG-and FEC-PET/CT was 40%*, 53%, 53%, 63%*, and 67% for all cases (*, P = 0.016); 10%, 10%, 20%, 30%, and 25% in cervical cancer (n = 40); 65%, 75%, 70%, 80% and 88% in endometrial cancer (n = 78). FDG-PET/CT outperformed nodal size (P = 0.006) and size ratio (P = 0.04) for per-region sensitivity. False positive rates were all <10%. Conclusions: All imaging techniques had low sensitivity for detection of nodal metastases and cannot replace surgical nodal staging. The performance of FEC-PET/CT was not statistically different from other techniques that are more widely available. FDG-PET/CT had higher sensitivity than size in detecting nodal metastases. False positive rates were low across all methods. The low false positive rate demonstrated by FDG-PET/CT may be helpful in arbitration of challenging surgical planning decisions.

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