TY - JOUR
T1 - Preoperative PET/CT does not accurately detect extrauterine disease in patients with newly diagnosed high-risk endometrial cancer
T2 - A prospective study
AU - Stewart, Katherine I.
AU - Chasen, Beth
AU - Erwin, William
AU - Fleming, Nicole
AU - Westin, Shannon N.
AU - Dioun, Shayan
AU - Frumovitz, Michael
AU - Ramirez, Pedro T.
AU - Lu, Karen H.
AU - Wong, Franklin
AU - Aloia, Thomas A.
AU - Soliman, Pamela T.
N1 - Funding Information:
William Erwin has received grants from FUJIFILM Radiopharmaceuticals USA Inc, Alfasigma S.p.A, Oncosil Medical Ltd, the Rita Foundation, RadioMedix Inc, and the National Institutes of Health/National Cancer Institute for work performed outside of the current study. Shannon N. Westin has received a grant from the National Institutes of Health for work performed as part of the current study and has received research support grants from AstraZeneca, Clovis, Tesaro, Roche/Genentech, Cotinga Pharmaceuticals, and Novartis and personal fees from Merck and Pfizer for work performed outside of the current study. Michael Frumovitz has received grants and personal fees from Novadaq/Stryker; grants from Navidea Biopharmaceuticals Inc; and personal fees from Johnson and Johnson, Genentech, and Ipsen for work performed outside of the current study. Pamela T. Soliman has received research support grants from Novartis and personal fees from Clovis Oncology for work performed outside of the current study. The other authors made no disclosures. Supported in part by the National Institutes of Health T32 training grant for gynecologic oncologists (CA101642), a Cancer Center Support Grant (National Cancer Institute grant P30 CA016672), and National Cancer Institute SPORE in Uterine Cancer (2P50 CA098258-06).
Publisher Copyright:
© 2019 American Cancer Society
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Background: The identification of extrauterine disease is critical to the management of patients with high-risk endometrial cancer. The purpose of the current study was to determine the accuracy of preoperative positron emission tomography (PET)/computed tomography (CT) in the detection of extrauterine disease. Methods: Women with high-risk endometrial cancer were enrolled prospectively and underwent preoperative PET/CT followed by surgery, including sentinel lymph node biopsy and lymphadenectomy. Primary tumor factors on PET/CT were correlated with lymph node pathology. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the detection of lymphadenopathy and peritoneal disease by PET/CT. Results: A total of 112 patients were enrolled and underwent PET/CT between April 2013 and May 2016, 108 of whom were evaluable. On PET/CT, 21 patients (19.4%) were found to have extrauterine disease, 18 (17%) had positive lymph nodes, and 8 (7%) had peritoneal disease. A total of 108 patients underwent surgery, 103 of whom (95%) underwent lymphadenectomy. The sensitivity of PET/CT to detect positive lymph nodes was 45.8%, with a specificity of 91.1%, positive predictive value of 61.1%, and negative predictive value of 84.7%. The false-negative rate was 54.2%. There was no difference in primary tumor characteristics on imaging noted between patients with positive and negative lymph nodes. The sensitivity of PET/CT to detect peritoneal disease was 37.5%, with a specificity of 97.8%, positive predictive value of 75%, and negative predictive value of 90.0%. The false-negative rate was 62.5%. Conclusions: Preoperative PET/CT did not reliably predict the presence of extrauterine disease in women with high-risk endometrial cancer. Given the high false-negative rates, PET/CT should not be used in the preoperative treatment planning of these patients.
AB - Background: The identification of extrauterine disease is critical to the management of patients with high-risk endometrial cancer. The purpose of the current study was to determine the accuracy of preoperative positron emission tomography (PET)/computed tomography (CT) in the detection of extrauterine disease. Methods: Women with high-risk endometrial cancer were enrolled prospectively and underwent preoperative PET/CT followed by surgery, including sentinel lymph node biopsy and lymphadenectomy. Primary tumor factors on PET/CT were correlated with lymph node pathology. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the detection of lymphadenopathy and peritoneal disease by PET/CT. Results: A total of 112 patients were enrolled and underwent PET/CT between April 2013 and May 2016, 108 of whom were evaluable. On PET/CT, 21 patients (19.4%) were found to have extrauterine disease, 18 (17%) had positive lymph nodes, and 8 (7%) had peritoneal disease. A total of 108 patients underwent surgery, 103 of whom (95%) underwent lymphadenectomy. The sensitivity of PET/CT to detect positive lymph nodes was 45.8%, with a specificity of 91.1%, positive predictive value of 61.1%, and negative predictive value of 84.7%. The false-negative rate was 54.2%. There was no difference in primary tumor characteristics on imaging noted between patients with positive and negative lymph nodes. The sensitivity of PET/CT to detect peritoneal disease was 37.5%, with a specificity of 97.8%, positive predictive value of 75%, and negative predictive value of 90.0%. The false-negative rate was 62.5%. Conclusions: Preoperative PET/CT did not reliably predict the presence of extrauterine disease in women with high-risk endometrial cancer. Given the high false-negative rates, PET/CT should not be used in the preoperative treatment planning of these patients.
KW - endometrial cancer
KW - extrauterine disease
KW - lymph nodes
KW - lymphadenectomy
KW - peritoneal disease
KW - preoperative positron emission tomography/computed tomography (PET/CT)
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U2 - 10.1002/cncr.32329
DO - 10.1002/cncr.32329
M3 - Article
C2 - 31225906
AN - SCOPUS:85067897985
SN - 0008-543X
VL - 125
SP - 3347
EP - 3353
JO - Cancer
JF - Cancer
IS - 19
ER -