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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

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Title: 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
Authors: Rockall, A
Barwick, T
Wilson, W
Singh, N
Bharwani, N
Sohaib, A
Nobbenhuis, M
Warbey, V
Miquel, M
Koh, D-M
De Paepe, KN
Martin-Hirsch, P
Ghaem-Maghami, S
Fotopoulou, C
Stringfellow, H
Sundar, S
Manchanda, R
Sahdev, A
Hackshaw, A
Cook, GJ
MAPPING Study Group
Item Type: Journal Article
Abstract: Purpose: Pre-operative nodal staging is important for planning treatment in cervical cancer (CC) and endometrial cancer (EC) 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 morphological MRI. Experimetal Design: A prospective, multicentre observational study of diagnostic accuracy for nodal metastases was undertaken in 5 gyne-oncology centres. FEC-PET/CT, FDG-PET/CT and DW-MRI were compared to nodal size and morphology on MRI. Reference standard was strictly correlated nodal histology. Eligibility included operable CC stage=>1B1 or EC (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. 267 nodal regions in 118 women 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 were 40%*, 53%, 53%, 63%* and 67% for all cases (*p=0.016); 10%, 10%, 20%, 30% and 25% in CC (n=40); 65%, 75%, 70%, 80% and 88% in EC (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 to 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.
Issue Date: 15-Sep-2021
Date of Acceptance: 13-Sep-2021
URI: http://hdl.handle.net/10044/1/91630
DOI: 10.1158/1078-0432.CCR-21-1834
ISSN: 1078-0432
Publisher: American Association for Cancer Research
Start Page: 6457
End Page: 6466
Journal / Book Title: Clinical Cancer Research
Volume: 27
Issue: 23
Copyright Statement: © 2021 Copyright held by the owner/author(s). This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs International 4.0 License.
Sponsor/Funder: Imperial College Healthcare NHS Trust- BRC Funding
Funder's Grant Number: RDC04
Keywords: Science & Technology
Life Sciences & Biomedicine
MAPPING Study Group
Oncology & Carcinogenesis
1112 Oncology and Carcinogenesis
Publication Status: Published
Online Publication Date: 2021-09-15
Appears in Collections:Department of Surgery and Cancer
Faculty of Medicine

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