Abstract
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.
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.
| Original language | English |
|---|---|
| Pages (from-to) | 6457-6466 |
| Number of pages | 10 |
| Journal | Clinical Cancer Research |
| Volume | 27 |
| Issue number | 23 |
| Early online date | 15 Sept 2021 |
| DOIs | |
| Publication status | Published - Dec 2021 |
Bibliographical note
Funding Information:The MAPPING study group authors are as follows: Victoria Stewart, Alan Farthing, Maria Kyrgiou, Joseph Yazbek, Roberto Dina, Thomas Ind, Desmond Barton, John Butler, Ayoma Attygalle, Steve Hazell, Alexandra Taylor, Susan Lalon-drelle, Imene Zerizer, Diana Rosof-Williams, Mike Dobson, Jonathan Hill, Elly Brockbank, Alexandra Lawrence, Arjun Jeyarajah, David Oram, Raji Ganesan, Peter Guest, Mark Davies, Laura Vosper, Carike Coetzee. We acknowledge the support of Evis Sala, Norbert Avril, Rodney Reznek, Lesley Honeyfield, Richard Edmondson, Neva Patel, Sameer Khan, Lucy Pike, Priya Narayanan, Nicholas Reed, Raj Naik, Shah-Jalal Sarker, Iain McNeish, The authors acknowledge support from Biomarkers and Imaging Discovery and Development (BIDD) Project Grant; Cancer Research UK (chief investigator: A.G. Rockall, C. Coetzee, L. Vosper), National Institute of Health Research Imperial Biomedical Centre and the Imperial Cancer Research UK Centre (to A.G. Rockall, T.D. Barwick, S. Ghaem-Maghami, C. Fotopoulou, M. Kyrgiou), Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom (to R. Manchanda, M. Miquel, N. Singh, A. Sahdev), National Institute for Health Research Biomedical Research Centre at Guy’s & St Thomas’ Hospitals and King’s College London, King’s College London/University College London Comprehensive Cancer Imaging Centre funded by Cancer Research UK and Engineering and Physical Sciences Research Council in association with the Medical Research Council and the Department of Health (C1519/ A16463; to G.J. Cook, V. Warbey), National Institute for Health Research (NIHR) Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London (to A. Sohaib, M. Nobbenhuis, T. Ind, D. Barton, J. Butler, A. Attygalle, S. Hazell, A. Taylor, S. Lalondrelle, I. Zerizer, K.N. De Paepe, D.-M. Koh), Cancer Research UK (C444/A15953), with support from the University College London and University College London Hospital Biomedical Research Centre (to A. Hackshaw), Alliance Medical sites for PET/CT research slots at Lancashire Teaching Hospitals NHS Foundation Trust. The Clinical Trials Units were as follows: Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, Barts Health NHS Trust, and Queen Mary University of London Joint Research Management Office.
MAPPING is a multicenter, prospective observational study evaluating the diagnostic accuracy for detecting nodal metastases using different imaging methods. Ethics approval, ARSAC licence, and MHRA approvals were obtained (Research Ethics Committee reference number 11/LO/1465). The study was sponsored by Barts Health NHS Trust. The Centre for Experimental Cancer Medicine (CECM), Barts Cancer Institute, Queen Mary University of London had overall responsibility for trial management. All participants gave written informed consent.
A.G. Rockall reports grants from Cancer Research UK during the conduct of the study. A. Sohaib reports other support from NIHR BRC funding during the conduct of the study. S. Ghaem-Maghami reports grants from Cancer Research UK Charity during the conduct of the study as well as grants from Eve Appeal charity and NIHR outside the submitted work. C. Fotopoulou reports personal fees and other support from Roche, AstraZeneca, Sequana, Tesaro, GSK, MSD, Clovis, and Ethicon outside the submitted work. R. Manchanda reports grants from CRUK, Barts Charity, Eve Appeal, and Rosetrees Trust and other support from GSK and AstraZeneca outside the submitted work. A. Sahdev reports grants from St Bartholomew’s Hospital during the conduct of the study. G.J. Cook reports grants from CRUK during the conduct of the study. No disclosures were reported by the other authors.
ASJC Scopus subject areas
- Oncology
- Cancer Research
