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Diagnostic Performance of Fluorine 18 Fluorodeoxyglucose Positron Emission Tomography Imaging for Detection of Primary Lesion and Staging of Endometrial Cancer Patients: Systematic Review and Meta-Analysis of the Literature

Kakhki, Vahid Reza Dabbagh MD*; Shahriari, Sara MD; Treglia, Giorgio MD; Hasanzadeh, Malihe MD; Zakavi, Seyed Rasoul MD*; Yousefi, Zohreh MD; Kadkhodayan, Sima MD; Sadeghi, Ramin MD*

International Journal of Gynecological Cancer: November 2013 - Volume 23 - Issue 9 - p 1536–1543
doi: 10.1097/IGC.0000000000000003
Review Articles

Objectives Fluorine 18 fluorodeoxyglucose positron emission tomography (18F-FDG PET) imaging has been used for staging of endometrial cancer. In the current study, we systematically searched the available literature on the accuracy of 18F-FDG PET imaging for staging of endometrial cancer.

Methods PubMed, SCOPUS, ISI Web of Knowledge, Science Direct, and Springer were searched using “endometr* AND PET” as the search terms. All studies evaluating the accuracy of 18F-FDG PET in the staging of endometrial carcinoma were included. Statistical pooling of diagnostic accuracy indices was done using random-effects model. Cochrane Q test and I 2 index were used for heterogeneity evaluation.

Results Sixteen studies (807 patients in total) were included in the meta-analysis. Sensitivity and specificity for detection of the primary lesions were 81.8% (77.9%–85.3%) and 89.8% (79.2%–96.2%); for lymph node staging were 72.3% (63.8%–79.8%) and 92.9% (90.6%–94.8%); and for distant metastasis detection were 95.7% (85.5%–99.5%) and 95.4% (92.7%–97.3%).

Conclusions Because of low sensitivity, diagnostic utility of 18F-FDG PET imaging is limited in primary tumor detection and lymph node staging of endometrial cancer patients. However, high specificities ensure high positive predictive values in these 2 indications. Diagnostic performance of 18F-FDG PET imaging is much better in detection of distant metastases. Larger studies with better design are needed to draw any more definite conclusion.

Supplemental digital content is available in the text.

*Nuclear Medicine Research Center and †Women’s Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; and ‡Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.

Address correspondence and reprint requests to Ramin Sadeghi, MD, Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. E-mail:;

This study is the result of a residency thesis that was conducted in Women’s Health and Nuclear Medicine Research Centers of Mashhad University of Medical Sciences under the approval number 900786.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (

The authors declare no conflicts of interest.

Received February 27, 2013

Accepted August 18, 2013

© 2013 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.