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 I2 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.

*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: sadeghir@mums.ac.ir; raminsadeghi1355@yahoo.com.

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.

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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.