Damian McNamara

June 14, 2016

SAN DIEGO — For the detection of metastases associated with endometrial cancer, overall accuracy is 88% with ¹⁸F-fluorodeoxyglucose PET integrated with CT (¹⁸F-FDG PET/CT), a systematic review and meta-analysis reveal. And for the detection of postsurgical recurrence, overall accuracy is 93%.

"This approach minimizes overtreatment, minimizes undertreatment, and maximizes outcome," said Vikram Rao Bollineni, MD, PhD, from the University of Bergen in Norway.

"If noninvasive imaging could accurately preclude lymph node metastasis before treatment," for example, it would help surgeons decide whether or not to proceed with lymphadenectomy, Dr Bollineni told Medscape Medical News.

Lymphadenectomy is an invasive procedure that increases the time and cost of diagnosis and the risks for morbidity and postoperative complications.

The findings were presented here at the Society of Nuclear Medicine and Molecular Imaging 2016 Annual Meeting, and were published in the June issue of the Journal of Nuclear Medicine.

Dr Bollineni and his colleagues identified 62 studies reporting the diagnostic performance of ¹⁸F-FDG PET/CT from PubMed and MEDLINE databases. After exclusions, they assessed 13 studies with 861 patients looking at the detection of lymph node metastases and another eight studies with 378 patients looking at the detection of endometrial cancer recurrence.

A number of statistical analyses support the high diagnostic accuracy of the imaging strategy, Dr Bollineni reported.

Table. Pooled Results on the Diagnostic Accuracy of ¹⁸FDG PET/CT

Outcome Lymph Node Metastases Recurrence
Sensitivity 0.72 0.95
Specificity 0.94 0.91
Positive-likelihood ratio 10.90 8.80
Negative-likelihood ratio 0.36 0.08
Diagnostic odds ratio 39.70 171.70
Receiver operator characteristic area under the curve 0.94 0.97

 

For the detection of lymph node metastases, sensitivity was moderate. It might have been limited by lymph nodes 4 mm or smaller, the spatial resolution of the scanner, and glucose metabolism of the lymph node, Dr Bollineni explained.

In contrast, specificity was "very high," so this imaging technique could be used to rule out unnecessary surgery, he reported. And a positive-likelihood ratio of approximately 10 indicates conclusive evidence.

For the detection of endometrial cancer recurrence, sensitivity was also "very high," at 95%, said Dr Bollineni. Specificity was high, too, at 91%.

"Meta-analyses are important. When a clinician asks a PET person if FDG PET is good for endometrial cancer, at least they have some information now," said session moderator Farrokh Dehdashti, MD, from the Washington University School of Medicine in St. Louis, Missouri.

"Having those data can help a clinician decide whether to order PET or not," she added.

"It looks like, especially for recurrent endometrial cancer, it would be very useful," Dr Dehdashti told Medscape Medical News.

Dr Bollineni reported that his team is currently recruiting participants for a prospective study to confirm these results.

Dr Bollineni and Dr Dehdashti have disclosed no relevant financial relationships.

Society of Nuclear Medicine and Molecular Imaging (SNMMI) 2016 Annual Meeting: Abstract 76. Presented June 12, 2016.

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