The role of 18F-FDG PET/CT in endometrial adenocarcinoma: a review of the literature and recent advances
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SYSTEMATIC REVIEW
The role of 18F‑FDG PET/CT in endometrial adenocarcinoma: a review of the literature and recent advances Ludovico M. Garau1 · Artor Niccoli‑Asabella1 · Cristina Ferrari2 · Angela Sardaro3 · Antonio Pisani1 · Giuseppe Rubini2 Received: 4 July 2020 / Accepted: 31 August 2020 © Italian Association of Nuclear Medicine and Molecular Imaging 2020
Abstract Purpose To provide a substantial coverage on the role of 18F-FDG PET/CT in endometrial cancer (EC), and identify the key issues which make its use recommended with both low level of evidence and low strength of recommendation in accordance with the last consensus conference. Methods A comprehensive literature computer search was performed on PubMed/MEDLINE and Cochrane Library databases up to June 2020. Included studies had to focus on 18F-FDG PET/CT in EC, with regard to staging, follow-up and prognostic value. Review guidelines, systematic review, meta-analyses and original papers were included. Results The 18F-FDG PET/CT is affected by suboptimal soft tissue differentiation, with sensitivity and specificity in tumor staging ranged from 77 to 85% and 79 to 96%. The sensitivity and the specificity of 18F-FDG PET/CT performed at staging for lymph node metastases ranged from 63 to 73% and 96 to 97%. For distant metastases, sensitivity and specificity of 18FFDG PET/CT performed at staging ranged from 63 to 80% and 93 to 96%. After treatment, better performance emerged for EC recurrent with sensitivity ranged from 92 to 98% and specificity ranged from 89 to 94%. Maximum standardized uptake value (SUVmax) and metabolic volumetric parameters, such as total lesion glycolysis (TLG) and metabolic tumor volume (MTV), resulted to be significantly related to prognosis. Conclusion Despite evidence-based data about the diagnostic performance are increasing, the low sensitivity represents the main limitation of 18F-FDG PET/CT imaging utilization for the detection of primary tumor and lymph node metastases. Better performances were observed for distant metastasis and EC recurrence. Further randomized prospective studies are needed to increase both the low level of evidence and low strength of recommendation for using 18F-FDG PET/CT in EC. Promising results emerged from PET/MRI. Keywords Endometrial cancer · PET/CT · Pelvic lymph node metastasis · Para-aortic lymph node metastasis · Systematic review · Meta-analysis
Introduction
* Ludovico M. Garau [email protected] 1
Nuclear Medicine Unit, “Antonio Perrino” Hospital, 72100 Brindisi, Italy
2
Nuclear Medicine Unit, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
3
Section of Radiology and Radiation Oncology, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70124 Bari, Italy
Endometrial carcinoma (EC) is the most common gynecologic malignancy in the developed country, and the incidence is increasing [1]. The prognosis is mostly determined by grade and stage. The International Federation of Gynecology and Obstetrics (FIGO)
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