Additional Value of FDG-PET/MRI Complementary to Sentinel Lymphonodectomy for Minimal Invasive Lymph Node Staging in Patients with Endometrial Cancer: A Prospective Study
Background: Lymph node metastases (LNM) are rare in early-stage endometrial cancer, but a diagnostic systematic lymphadenectomy (LNE) is often performed to achieve reliable N-staging. Therefore, this prospective study aimed to evaluate the benefit of [18F]-Fluorodeoxyglucose (FDG) PET/MRI complement...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2024-02-01
|
| Series: | Diagnostics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-4418/14/4/376 |
| _version_ | 1797298523475017728 |
|---|---|
| author | Matthias Weissinger Lidia Bala Sara Yvonne Brucker Stefan Kommoss Sascha Hoffmann Ferdinand Seith Konstantin Nikolaou Christian la Fougère Christina Barbara Walter Helmut Dittmann |
| author_facet | Matthias Weissinger Lidia Bala Sara Yvonne Brucker Stefan Kommoss Sascha Hoffmann Ferdinand Seith Konstantin Nikolaou Christian la Fougère Christina Barbara Walter Helmut Dittmann |
| author_sort | Matthias Weissinger |
| collection | DOAJ |
| description | Background: Lymph node metastases (LNM) are rare in early-stage endometrial cancer, but a diagnostic systematic lymphadenectomy (LNE) is often performed to achieve reliable N-staging. Therefore, this prospective study aimed to evaluate the benefit of [18F]-Fluorodeoxyglucose (FDG) PET/MRI complementary to SPECT/CT guided sentinel lymphonodectomy (SLNE) for a less invasive N-staging Methods: 79 patients underwent a whole-body FDG-PET/MRI, SLN mapping with <sup>99m</sup>Tc-Nanocolloid SPECT/CT and indocyanine green (ICG) fluoroscopy followed by LNE which served as ground truth. Results: FDG-PET/MRI was highly specific in N-staging (97.2%) but revealed limited sensitivity (66.7%) due to missed micrometastases. In contrast, bilateral SLN mapping failed more often in patients with macrometastases. The combination of SLN mapping and FDG-PET/MRI increased the sensitivity from 66.7% to 77.8%. Additional SLN labeling with dye (ICG) revealed a complete SLN mapping in 80% (8/10) of patients with failed or incomplete SLN detection in SPECT/CT, reducing the need for diagnostic systematic LNE up to 87%. FDG-PET/MRI detected para-aortic LNM in three out of four cases and a liver metastasis. Conclusions: The combination of FDG-PET/MRI and SLNE can reduce the need for diagnostic systematic LNE by up to 87%. PET/MRI complements the SLN technique particularly in the detection of para-aortic LNM and occasional distant metastases. |
| first_indexed | 2024-03-07T22:36:04Z |
| format | Article |
| id | doaj.art-e908ca5f352b49f78ad58817c40173f8 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-07T22:36:04Z |
| publishDate | 2024-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-e908ca5f352b49f78ad58817c40173f82024-02-23T15:13:43ZengMDPI AGDiagnostics2075-44182024-02-0114437610.3390/diagnostics14040376Additional Value of FDG-PET/MRI Complementary to Sentinel Lymphonodectomy for Minimal Invasive Lymph Node Staging in Patients with Endometrial Cancer: A Prospective StudyMatthias Weissinger0Lidia Bala1Sara Yvonne Brucker2Stefan Kommoss3Sascha Hoffmann4Ferdinand Seith5Konstantin Nikolaou6Christian la Fougère7Christina Barbara Walter8Helmut Dittmann9Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, GermanyDepartment of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, 72076 Tuebingen, GermanyDepartment of Women’s Health, University Hospital Tuebingen, 72076 Tuebingen, GermanyDepartment of Women’s Health, University Hospital Tuebingen, 72076 Tuebingen, GermanyDepartment of Women’s Health, University Hospital Tuebingen, 72076 Tuebingen, GermanyDepartment of Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, GermanyDepartment of Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, GermanyDepartment of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, 72076 Tuebingen, GermanyDepartment of Women’s Health, University Hospital Tuebingen, 72076 Tuebingen, GermanyDepartment of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, 72076 Tuebingen, GermanyBackground: Lymph node metastases (LNM) are rare in early-stage endometrial cancer, but a diagnostic systematic lymphadenectomy (LNE) is often performed to achieve reliable N-staging. Therefore, this prospective study aimed to evaluate the benefit of [18F]-Fluorodeoxyglucose (FDG) PET/MRI complementary to SPECT/CT guided sentinel lymphonodectomy (SLNE) for a less invasive N-staging Methods: 79 patients underwent a whole-body FDG-PET/MRI, SLN mapping with <sup>99m</sup>Tc-Nanocolloid SPECT/CT and indocyanine green (ICG) fluoroscopy followed by LNE which served as ground truth. Results: FDG-PET/MRI was highly specific in N-staging (97.2%) but revealed limited sensitivity (66.7%) due to missed micrometastases. In contrast, bilateral SLN mapping failed more often in patients with macrometastases. The combination of SLN mapping and FDG-PET/MRI increased the sensitivity from 66.7% to 77.8%. Additional SLN labeling with dye (ICG) revealed a complete SLN mapping in 80% (8/10) of patients with failed or incomplete SLN detection in SPECT/CT, reducing the need for diagnostic systematic LNE up to 87%. FDG-PET/MRI detected para-aortic LNM in three out of four cases and a liver metastasis. Conclusions: The combination of FDG-PET/MRI and SLNE can reduce the need for diagnostic systematic LNE by up to 87%. PET/MRI complements the SLN technique particularly in the detection of para-aortic LNM and occasional distant metastases.https://www.mdpi.com/2075-4418/14/4/376endometrial cancer stagingFDG PET/MRI<sup>99m</sup>Tc-Nanocolloid SPECT/CTmicrometastasesN-stagingpara-aortic lymph node metastases |
| spellingShingle | Matthias Weissinger Lidia Bala Sara Yvonne Brucker Stefan Kommoss Sascha Hoffmann Ferdinand Seith Konstantin Nikolaou Christian la Fougère Christina Barbara Walter Helmut Dittmann Additional Value of FDG-PET/MRI Complementary to Sentinel Lymphonodectomy for Minimal Invasive Lymph Node Staging in Patients with Endometrial Cancer: A Prospective Study Diagnostics endometrial cancer staging FDG PET/MRI <sup>99m</sup>Tc-Nanocolloid SPECT/CT micrometastases N-staging para-aortic lymph node metastases |
| title | Additional Value of FDG-PET/MRI Complementary to Sentinel Lymphonodectomy for Minimal Invasive Lymph Node Staging in Patients with Endometrial Cancer: A Prospective Study |
| title_full | Additional Value of FDG-PET/MRI Complementary to Sentinel Lymphonodectomy for Minimal Invasive Lymph Node Staging in Patients with Endometrial Cancer: A Prospective Study |
| title_fullStr | Additional Value of FDG-PET/MRI Complementary to Sentinel Lymphonodectomy for Minimal Invasive Lymph Node Staging in Patients with Endometrial Cancer: A Prospective Study |
| title_full_unstemmed | Additional Value of FDG-PET/MRI Complementary to Sentinel Lymphonodectomy for Minimal Invasive Lymph Node Staging in Patients with Endometrial Cancer: A Prospective Study |
| title_short | Additional Value of FDG-PET/MRI Complementary to Sentinel Lymphonodectomy for Minimal Invasive Lymph Node Staging in Patients with Endometrial Cancer: A Prospective Study |
| title_sort | additional value of fdg pet mri complementary to sentinel lymphonodectomy for minimal invasive lymph node staging in patients with endometrial cancer a prospective study |
| topic | endometrial cancer staging FDG PET/MRI <sup>99m</sup>Tc-Nanocolloid SPECT/CT micrometastases N-staging para-aortic lymph node metastases |
| url | https://www.mdpi.com/2075-4418/14/4/376 |
| work_keys_str_mv | AT matthiasweissinger additionalvalueoffdgpetmricomplementarytosentinellymphonodectomyforminimalinvasivelymphnodestaginginpatientswithendometrialcanceraprospectivestudy AT lidiabala additionalvalueoffdgpetmricomplementarytosentinellymphonodectomyforminimalinvasivelymphnodestaginginpatientswithendometrialcanceraprospectivestudy AT sarayvonnebrucker additionalvalueoffdgpetmricomplementarytosentinellymphonodectomyforminimalinvasivelymphnodestaginginpatientswithendometrialcanceraprospectivestudy AT stefankommoss additionalvalueoffdgpetmricomplementarytosentinellymphonodectomyforminimalinvasivelymphnodestaginginpatientswithendometrialcanceraprospectivestudy AT saschahoffmann additionalvalueoffdgpetmricomplementarytosentinellymphonodectomyforminimalinvasivelymphnodestaginginpatientswithendometrialcanceraprospectivestudy AT ferdinandseith additionalvalueoffdgpetmricomplementarytosentinellymphonodectomyforminimalinvasivelymphnodestaginginpatientswithendometrialcanceraprospectivestudy AT konstantinnikolaou additionalvalueoffdgpetmricomplementarytosentinellymphonodectomyforminimalinvasivelymphnodestaginginpatientswithendometrialcanceraprospectivestudy AT christianlafougere additionalvalueoffdgpetmricomplementarytosentinellymphonodectomyforminimalinvasivelymphnodestaginginpatientswithendometrialcanceraprospectivestudy AT christinabarbarawalter additionalvalueoffdgpetmricomplementarytosentinellymphonodectomyforminimalinvasivelymphnodestaginginpatientswithendometrialcanceraprospectivestudy AT helmutdittmann additionalvalueoffdgpetmricomplementarytosentinellymphonodectomyforminimalinvasivelymphnodestaginginpatientswithendometrialcanceraprospectivestudy |