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IMR Press / EJGO / Volume 42 / Issue 6 / DOI: 10.31083/j.ejgo4206165
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High diagnostic value of 18F-FDG PET/CT in detecting endometrial cancer in patients with precancerous endometrial lesions
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1 Department of Obstetrics & Gynecology, Division of Gynaecologic Oncology, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada
2 Department of Nuclear Medicine, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada
Eur. J. Gynaecol. Oncol. 2021 , 42(6), 1130–1137; https://doi.org/10.31083/j.ejgo4206165
Submitted: 30 September 2021 | Revised: 18 October 2021 | Accepted: 25 October 2021 | Published: 15 December 2021
This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/).
Abstract

Objective: Up to 60% of patients with a precancerous endometrial lesion will ultimately be diagnosed with endometrial carcinoma. In the context of endometrial carcinoma, adequate surgical staging—including lymph-node assessment—should be performed and dictate the necessity of postoperative adjuvant treatments. Our main objective was to evaluate the diagnostic performance of preoperative Positron Emission Tomography-Computed Tomography (PET/CT) in identifying concomitant endometrial cancer in patients with confirmed precancerous endometrial lesions. Methods: All women diagnosed with a precancerous lesion between 2010 and 2018 in our center were included in this retrospective cohort study. Patients were then divided into groups according to whether or not a PET/CT was performed preoperatively and the presence of endometrial carcinoma at the final pathology. Results: A total of 128 patients met the inclusion criteria, of which 66 underwent PET/CT. The sensitivity of PET/CT in identifying carcinoma was 78.3%, with a specificity of 79.1%. PET/CT failed to identify carcinoma in 5 out of 66 patients (7.6%). In the PET/CT group, 18 of 23 patients (78.3%) had adequate surgical staging, compared to only 4 of 31 patients (12.9%) in the standard group (p $<$ 0.00001). Conclusion: Preoperative PET/CT reliably predicted the presence of endometrial carcinoma in women with precancerous endometrial lesions. Future trials should explore the value of adding PET/CT in the preoperative investigation of these patients to identify women who may be offered sentinel-lymph node mapping.

Keywords
Endometrial cancer
Precancerous endometrial lesions
Endometrial hyperplasia
Surgical staging