Purpose: Preoperative nodal staging is important for planning treatment in cervical cancer and endometrial cancer, 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 morphologic MRI. Experimental Design: A prospective, multicenter observational study of diagnostic accuracy for nodal metastases was undertaken in 5 gyne-oncology centers. FEC-PET/CT, FDG-PET/CT, and DW-MRI were compared with nodal size and morphology on MRI. Reference standard was strictly correlated nodal histology. Eligibility included operable cervical cancer stage ≥ 1B1 or endometrial cancer (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. In 118 patients, 267 nodal regions 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 was 40%*, 53%, 53%, 63%*, and 67% for all cases (*, P = 0.016); 10%, 10%, 20%, 30%, and 25% in cervical cancer ( n = 40); 65%, 75%, 70%, 80% and 88% in endometrial cancer ( 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 from 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.

中文翻译：

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FEC-PET/CT、FDG-PET/CT 和扩散加权 MRI 检测手术治疗的子宫内膜癌和宫颈癌淋巴结转移的诊断准确性


目的：术前淋巴结分期对于宫颈癌和子宫内膜癌的治疗规划很重要，但仍然具有挑战性。我们将 18F-乙基胆碱-(FEC)-PET/CT、18F-氟脱氧葡萄糖-(FDG)-PET/CT 和扩散加权 MRI (DW-MRI) 的淋巴结分期准确性与传统形态学进行比较核磁共振成像。实验设计：在 5 个妇科肿瘤中心进行了一项关于淋巴结转移诊断准确性的前瞻性、多中心观察性研究。将 FEC-PET/CT、FDG-PET/CT 和 DW-MRI 与 MRI 上的淋巴结大小和形态进行比较。参考标准是严格相关的淋巴结组织学。资格包括可手术的宫颈癌分期 ≥ 1B1 或子宫内膜癌（任何具有肌层浸润的 3 级或 1-2 级 ≥ II 期）。结果：在 162 名同意的参与者中，136 名接受了 DW-MRI 和 FDG-PET/CT 研究，60 名接受了 FEC-PET/CT。在 118 名患者中，267 个淋巴结区域在组织学上严格相关（淋巴结阳性率为 25%）。每个患者 (n = 118) 对淋巴结大小、形态、DW-MRI、FDG 和 FEC-PET/CT 的敏感性分别为 40%*、53%、53%、63%* 和所有病例的 67%（*、 P = 0.016）；宫颈癌的发生率为 10%、10%、20%、30% 和 25%（n = 40）；子宫内膜癌的发生率为 65%、75%、70%、80% 和 88% ( n = 78)。对于每个区域的敏感性，FDG-PET/CT 优于节点尺寸 (P = 0.006) 和尺寸比 (P = 0.04)。假阳性率均为<10%。结论：所有影像学技术检测淋巴结转移的敏感性均较低，不能替代手术淋巴结分期。 FEC-PET/CT 的性能与其他更广泛使用的技术没有统计学差异。 FDG-PET/CT 在检测淋巴结转移方面比大小具有更高的敏感性。所有方法的假阳性率都很低。 FDG-PET/CT 表现出的低假阳性率可能有助于仲裁具有挑战性的手术计划决策。