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
Andrea Rockall, Tara Barwick, William Wilson, Naveena Singh, Nishat Bharwani, Aslam Sohaib, Marielle Nobbenhuis, Victoria Warbey, Marc E. Miquel, Dow‐Mu Koh, Katja N. De Paepe, Pierre L. Martin‐Hirsch, Sadaf Ghaem‐Maghami, Christina Fotopoulou, Helen F. Stringfellow, Sudha Sundar, Ranjit Manchanda, Anju Sahdev, Allan Hackshaw, Gary Cook, MAPPING Study Group, Victoria Stewart, Alan Farthing, Maria Kyrgiou, Joseph Yazbek, Roberto Dina, Thomas Ind, Desmond Barton, John Butler, Ayoma Attygalle, Steve Hazell, Alexandra Taylor, Susan Lalondrelle, Imene Zerizer, Diana Rosof-Williams, Mike Dobson, Jonathan Hill, Elly Brockbank, Alexandra Lawrence, Arjun Jeyarajah, David Oram, Raji Ganesan, Peter Guest, Mark Davies, Laura Vosper, Carike Coetzee
Abstract
Abstract Purpose: Preoperative nodal staging is important for planning treatment in cervical cancer and endometrial cancer, but remains challenging. We compare nodal staging accuracy of 18F-ethyl-choline-(FEC)-PET/CT, 18F-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 underwent 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.