Diagnostic performance of quantitative measures from [18F]FDG PET/CT, [         18F]FEC PET/CT, and DW-MRI in the detection of lymph node metastases in endometrial and cervical cancer: data from the MAPPING study

Ben G. King; Nishat Bharwani; William Wilson; Gary J.R. Cook; Aslam Sohaib; Marielle Nobbenhuis; Victoria Warbey; Marc E. Miquel; Dow-Mu Koh; Katja N. De Paepe; Pierre Martin-Hirsch; Sadaf Ghaem-Maghami; Christina Fotopoulou; Helen Stringfellow; Sudha Sundar; Ranjit Manchanda; Anju Sahdev; Allan Hackshaw; Tara D. Barwick; Andrea G. Rockall

doi:10.1007/s00259-025-07587-3

Diagnostic performance of quantitative measures from [¹⁸F]FDG PET/CT, [ 18F]FEC PET/CT, and DW-MRI in the detection of lymph node metastases in endometrial and cervical cancer: data from the MAPPING study

Ben G. King
, Nishat Bharwani
, William Wilson
, Gary J.R. Cook
, Aslam Sohaib
, Marielle Nobbenhuis
, Victoria Warbey
, Marc E. Miquel
, Dow-Mu Koh
, Katja N. De Paepe
, Pierre Martin-Hirsch
, Sadaf Ghaem-Maghami
, Christina Fotopoulou
, Helen Stringfellow
, Sudha Sundar
, Ranjit Manchanda
, Anju Sahdev
, Allan Hackshaw
, Tara D. Barwick^*
, Andrea G. Rockall

^*Corresponding author for this work

Cancer and Genomic Sciences

Research output: Contribution to journal › Article › peer-review

Abstract

Purpose: To evaluate the diagnostic performance of quantitative measures derived from [¹⁸F]FDG PET/CT, [¹⁸F]FEC PET/CT, and DW-MRI in the detection of lymph node metastases in endometrial and cervical cancer with comparison to standard visual PET analysis with histology as the reference standard.

Methods: Subanalysis of quantitative data from the prospective multicentre MAPPING study. Nodal and tumour SUV_max from [¹⁸F]FDG PET/CT and [¹⁸F]FEC PET/CT and ADC_mean from DW-MRI were documented. Nodal-to-tumour ratios (NTR) and SUV_max-to-ADC_mean ratio (STAR) were calculated. Optimal cut-offs of quantitative measures were compared to visual assessment on a regional basis using histopathology as the reference standard.

Results: Scans from 112 patients (36 cervical and 76 endometrial cancers; 340 nodal regions) were eligible for quantitative image analysis. Lower ADC_mean on DW-MRI was observed in metastatic nodes for cervical cancer but not for endometrial cancer. Quantitative measures were significantly higher in malignant than benign nodal regions on [¹⁸F]FDG PET/CT and [¹⁸F]FEC PET/CT in endometrial cancer. SUV_max cut-offs showed similar performance to visual assessment in the diagnosis of metastatic lymph nodes in endometrial cancer whilst ADC_mean cut-offs showed significantly lower specificity than visual assessment. Interobserver agreement was excellent for SUV_max measurements on both [¹⁸F]FDG PET/CT and [¹⁸F]FEC PET/CT, but poor for ADC_mean on DW-MRI.

Conclusion: Quantitative measures from [¹⁸F]FDG PET/CT, [¹⁸F]FEC PET/CT, or DW-MRI did not outperform visual assessment in the detection of nodal metastases in endometrial cancer. Therefore, the implementation of these quantitative measures as standalone diagnostic tools in routine clinical practice is not recommended.

Original language	English
Number of pages	13
Journal	European Journal Nuclear Medicine Molecular Imaging
Early online date	3 Nov 2025
DOIs	https://doi.org/10.1007/s00259-025-07587-3
Publication status	E-pub ahead of print - 3 Nov 2025

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King, B. G., Bharwani, N., Wilson, W., Cook, G. J. R., Sohaib, A., Nobbenhuis, M., Warbey, V., Miquel, M. E., Koh, D.-M., De Paepe, K. N., Martin-Hirsch, P., Ghaem-Maghami, S., Fotopoulou, C., Stringfellow, H., Sundar, S., Manchanda, R., Sahdev, A., Hackshaw, A., Barwick, T. D., & Rockall, A. G. (2025). Diagnostic performance of quantitative measures from [¹⁸F]FDG PET/CT, [ 18F]FEC PET/CT, and DW-MRI in the detection of lymph node metastases in endometrial and cervical cancer: data from the MAPPING study. European Journal Nuclear Medicine Molecular Imaging. Advance online publication. https://doi.org/10.1007/s00259-025-07587-3

@article{5061eccc1a034908a9dcfba584d816a1,

title = "Diagnostic performance of quantitative measures from [18F]FDG PET/CT, [ 18F]FEC PET/CT, and DW-MRI in the detection of lymph node metastases in endometrial and cervical cancer: data from the MAPPING study",

abstract = "Purpose: To evaluate the diagnostic performance of quantitative measures derived from [18F]FDG PET/CT, [18F]FEC PET/CT, and DW-MRI in the detection of lymph node metastases in endometrial and cervical cancer with comparison to standard visual PET analysis with histology as the reference standard. Methods: Subanalysis of quantitative data from the prospective multicentre MAPPING study. Nodal and tumour SUVmax from [18F]FDG PET/CT and [18F]FEC PET/CT and ADCmean from DW-MRI were documented. Nodal-to-tumour ratios (NTR) and SUVmax-to-ADCmean ratio (STAR) were calculated. Optimal cut-offs of quantitative measures were compared to visual assessment on a regional basis using histopathology as the reference standard. Results: Scans from 112 patients (36 cervical and 76 endometrial cancers; 340 nodal regions) were eligible for quantitative image analysis. Lower ADCmean on DW-MRI was observed in metastatic nodes for cervical cancer but not for endometrial cancer. Quantitative measures were significantly higher in malignant than benign nodal regions on [18F]FDG PET/CT and [18F]FEC PET/CT in endometrial cancer. SUVmax cut-offs showed similar performance to visual assessment in the diagnosis of metastatic lymph nodes in endometrial cancer whilst ADCmean cut-offs showed significantly lower specificity than visual assessment. Interobserver agreement was excellent for SUVmax measurements on both [18F]FDG PET/CT and [18F]FEC PET/CT, but poor for ADCmean on DW-MRI. Conclusion: Quantitative measures from [18F]FDG PET/CT, [18F]FEC PET/CT, or DW-MRI did not outperform visual assessment in the detection of nodal metastases in endometrial cancer. Therefore, the implementation of these quantitative measures as standalone diagnostic tools in routine clinical practice is not recommended. ",

author = "King, \{Ben G.\} and Nishat Bharwani and William Wilson and Cook, \{Gary J.R.\} and Aslam Sohaib and Marielle Nobbenhuis and Victoria Warbey and Miquel, \{Marc E.\} and Dow-Mu Koh and \{De Paepe\}, \{Katja N.\} and Pierre Martin-Hirsch and Sadaf Ghaem-Maghami and Christina Fotopoulou and Helen Stringfellow and Sudha Sundar and Ranjit Manchanda and Anju Sahdev and Allan Hackshaw and Barwick, \{Tara D.\} and Rockall, \{Andrea G.\}",

note = "{\textcopyright} 2025. The Author(s).",

year = "2025",

month = nov,

day = "3",

doi = "10.1007/s00259-025-07587-3",

language = "English",

journal = "European Journal Nuclear Medicine Molecular Imaging",

issn = "1619-7070",

publisher = "Springer",

}

King, BG, Bharwani, N, Wilson, W, Cook, GJR, Sohaib, A, Nobbenhuis, M, Warbey, V, Miquel, ME, Koh, D-M, De Paepe, KN, Martin-Hirsch, P, Ghaem-Maghami, S, Fotopoulou, C, Stringfellow, H, Sundar, S, Manchanda, R, Sahdev, A, Hackshaw, A, Barwick, TD & Rockall, AG 2025, 'Diagnostic performance of quantitative measures from [¹⁸F]FDG PET/CT, [ 18F]FEC PET/CT, and DW-MRI in the detection of lymph node metastases in endometrial and cervical cancer: data from the MAPPING study', European Journal Nuclear Medicine Molecular Imaging. https://doi.org/10.1007/s00259-025-07587-3

Diagnostic performance of quantitative measures from [¹⁸F]FDG PET/CT, [ 18F]FEC PET/CT, and DW-MRI in the detection of lymph node metastases in endometrial and cervical cancer: data from the MAPPING study. / King, Ben G.; Bharwani, Nishat; Wilson, William et al.
In: European Journal Nuclear Medicine Molecular Imaging, 03.11.2025.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Diagnostic performance of quantitative measures from [18F]FDG PET/CT, [ 18F]FEC PET/CT, and DW-MRI in the detection of lymph node metastases in endometrial and cervical cancer

T2 - data from the MAPPING study

AU - King, Ben G.

AU - Bharwani, Nishat

AU - Wilson, William

AU - Cook, Gary J.R.

AU - Sohaib, Aslam

AU - Nobbenhuis, Marielle

AU - Warbey, Victoria

AU - Miquel, Marc E.

AU - Koh, Dow-Mu

AU - De Paepe, Katja N.

AU - Martin-Hirsch, Pierre

AU - Ghaem-Maghami, Sadaf

AU - Fotopoulou, Christina

AU - Stringfellow, Helen

AU - Sundar, Sudha

AU - Manchanda, Ranjit

AU - Sahdev, Anju

AU - Hackshaw, Allan

AU - Barwick, Tara D.

AU - Rockall, Andrea G.

PY - 2025/11/3

Y1 - 2025/11/3

N2 - Purpose: To evaluate the diagnostic performance of quantitative measures derived from [18F]FDG PET/CT, [18F]FEC PET/CT, and DW-MRI in the detection of lymph node metastases in endometrial and cervical cancer with comparison to standard visual PET analysis with histology as the reference standard. Methods: Subanalysis of quantitative data from the prospective multicentre MAPPING study. Nodal and tumour SUVmax from [18F]FDG PET/CT and [18F]FEC PET/CT and ADCmean from DW-MRI were documented. Nodal-to-tumour ratios (NTR) and SUVmax-to-ADCmean ratio (STAR) were calculated. Optimal cut-offs of quantitative measures were compared to visual assessment on a regional basis using histopathology as the reference standard. Results: Scans from 112 patients (36 cervical and 76 endometrial cancers; 340 nodal regions) were eligible for quantitative image analysis. Lower ADCmean on DW-MRI was observed in metastatic nodes for cervical cancer but not for endometrial cancer. Quantitative measures were significantly higher in malignant than benign nodal regions on [18F]FDG PET/CT and [18F]FEC PET/CT in endometrial cancer. SUVmax cut-offs showed similar performance to visual assessment in the diagnosis of metastatic lymph nodes in endometrial cancer whilst ADCmean cut-offs showed significantly lower specificity than visual assessment. Interobserver agreement was excellent for SUVmax measurements on both [18F]FDG PET/CT and [18F]FEC PET/CT, but poor for ADCmean on DW-MRI. Conclusion: Quantitative measures from [18F]FDG PET/CT, [18F]FEC PET/CT, or DW-MRI did not outperform visual assessment in the detection of nodal metastases in endometrial cancer. Therefore, the implementation of these quantitative measures as standalone diagnostic tools in routine clinical practice is not recommended.

AB - Purpose: To evaluate the diagnostic performance of quantitative measures derived from [18F]FDG PET/CT, [18F]FEC PET/CT, and DW-MRI in the detection of lymph node metastases in endometrial and cervical cancer with comparison to standard visual PET analysis with histology as the reference standard. Methods: Subanalysis of quantitative data from the prospective multicentre MAPPING study. Nodal and tumour SUVmax from [18F]FDG PET/CT and [18F]FEC PET/CT and ADCmean from DW-MRI were documented. Nodal-to-tumour ratios (NTR) and SUVmax-to-ADCmean ratio (STAR) were calculated. Optimal cut-offs of quantitative measures were compared to visual assessment on a regional basis using histopathology as the reference standard. Results: Scans from 112 patients (36 cervical and 76 endometrial cancers; 340 nodal regions) were eligible for quantitative image analysis. Lower ADCmean on DW-MRI was observed in metastatic nodes for cervical cancer but not for endometrial cancer. Quantitative measures were significantly higher in malignant than benign nodal regions on [18F]FDG PET/CT and [18F]FEC PET/CT in endometrial cancer. SUVmax cut-offs showed similar performance to visual assessment in the diagnosis of metastatic lymph nodes in endometrial cancer whilst ADCmean cut-offs showed significantly lower specificity than visual assessment. Interobserver agreement was excellent for SUVmax measurements on both [18F]FDG PET/CT and [18F]FEC PET/CT, but poor for ADCmean on DW-MRI. Conclusion: Quantitative measures from [18F]FDG PET/CT, [18F]FEC PET/CT, or DW-MRI did not outperform visual assessment in the detection of nodal metastases in endometrial cancer. Therefore, the implementation of these quantitative measures as standalone diagnostic tools in routine clinical practice is not recommended.

U2 - 10.1007/s00259-025-07587-3

DO - 10.1007/s00259-025-07587-3

M3 - Article

C2 - 41177835

SN - 1619-7070

JO - European Journal Nuclear Medicine Molecular Imaging

JF - European Journal Nuclear Medicine Molecular Imaging

ER -

King BG, Bharwani N, Wilson W, Cook GJR, Sohaib A, Nobbenhuis M et al. Diagnostic performance of quantitative measures from [¹⁸F]FDG PET/CT, [ 18F]FEC PET/CT, and DW-MRI in the detection of lymph node metastases in endometrial and cervical cancer: data from the MAPPING study. European Journal Nuclear Medicine Molecular Imaging. 2025 Nov 3. Epub 2025 Nov 3. doi: 10.1007/s00259-025-07587-3