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Diagnostic accuracy of preoperative 18F-FDG PET or PET/CT in detecting pelvic and para-aortic lymph node metastasis in patients with endometrial cancer: a systematic review and meta-analysis

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Abstract

Purpose

The aim of this study was to assess the diagnostic accuracy of preoperative 18F-FDG PET or PET/CT in detecting pelvic lymph node (PLN) and para-aortic lymph node (PALN) metastasis in patients with endometrial cancer (EC) in systematic review and meta-analysis format.

Methods

A comprehensive search was performed on PubMed, Cochrane Library, EMBASE, Web of science, SpringerLink and Science Direct for studies reporting the diagnostic value of preoperative 18F-FDG PET or PET/CT in detecting PLN and PALN metastasis had been published up to August 8, 2018. Studies were included if enough data could be extracted for calculation of diagnostic accuracy indices.

Results

Nineteen studies (1431 patients in total) were included in the analysis. On a lymph node basis, the overall pooled sensitivity, specificity, AUC and overall diagnostic accuracy (Q* index) of 18F-FDG PET or PET/CT in detecting total lymph node metastasis were 0.68 (95% CI 0.63–0.73), 0.96 (95% CI 0.96–0.97), 0.82, and 0.75, respectively. The corresponding indices for detecting PLN metastasis were 0.61 (95% CI 0.52–0.69), 0.96 (95% CI 0.95–0.97), 0.79, and 0.73, respectively. And the corresponding value for detection of PALN were 0.70 (95% CI 0.58–0.79), 0.92 (95% CI 0.9–0.94), 0.84, and 0.77, respectively. Data based on patients also performed well.

Conclusions

18F-FDG PET and PET/CT both have excellent diagnostic performance for detecting lymph node metastasis, including PLN and PALN metastasis, in patients with endometrial cancer preoperatively. Though the utility of this method is limited due to its moderate sensitivity, it can help surgeons make better-tailored surgical decision for its high specificity.

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Acknowledgements

The authors thank Drs F. Xue and Drs Y. Wang for directing this systematic review and meta-analysis. This study was supported by grants from the Natural Science Foundation of China (No. 81772790 and No. 81572568).

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  1. Department of Obstetrics and Gynecology, Tianjin Medical University General Hospital, 154 Anshan Road, He Ping District, Tianjin, 300052, China

    Jiali Hu, Kai Zhang, Ye Yan, Yuqin Zang, Yingmei Wang & Fengxia Xue

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  1. Jiali Hu
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Contributions

JH: literature review and manuscript writing; KZ: designation of the tables and figures; YY: literature review and data analysis; YZ: language emendation; FX and YW: manuscript revision and providers of the funding for the project together.

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Correspondence to Yingmei Wang or Fengxia Xue.

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Hu, J., Zhang, K., Yan, Y. et al. Diagnostic accuracy of preoperative 18F-FDG PET or PET/CT in detecting pelvic and para-aortic lymph node metastasis in patients with endometrial cancer: a systematic review and meta-analysis. Arch Gynecol Obstet 300, 519–529 (2019). https://doi.org/10.1007/s00404-019-05207-8

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