ORIGINAL ARTICLE PET-CT scan in the preoperative workup of early stage intermediate- and high-risk endometrial cancer Massimo Franchi a , Simone Garzon a , Pier Carlo Zorzato a , Antonio Simone Lagan a b , Jvan Casarin b , Luisa Locantore c , Ricciarda Raffaelli a and Fabio Ghezzi b a Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy; b Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy; c Department of Diagnostics and Public Health, Nuclear Medicine Unit, AOUI Verona, University of Verona, Verona, Italy ABSTRACT Objectives: To evaluate positron emission tomography-computed tomography (PET-CT) for the preoperative management of early-stage intermediate- and high-risk endometrial cancer (EC). Study design: Data of patients with intermediate- and high-risk early-stage EC were retrieved from a prospectively collected database. Patients with preoperative PET-CT followed by surgical staging including pelvic lymphadenectomy were analyzed. Diagnostic performance for lymph node (LN) metastasis was evaluated. Results: Overall, 45 patients were included: 27 (60%) and 18 (40%) with intermediate- and high- risk EC, respectively. Four patients (8.8%) had LN metastasis, three correctly identified at PET-CT, yielding a sensitivity of 75% (95% CI 21.9–98.7). Among 41 patients (91.2%) without LN metasta- sis, 38 had negative PET-CT with specificity of 92.7% (95% CI 78.9–98.1). The negative predictive value (NPV) was 97.4% (95% CI 84.9–99.9) and the positive predictive value was 50% (95% CI 13.9–86.1). Conclusions: The utility of PET-CT is limited by the low sensitivity for LN metastasis in inter- mediate- and high-risk early-stage EC, that may impede to consider PET-CT alone an adequate alternative to surgical retroperitoneal staging by lymphadenectomy or sentinel LN biopsy. However, the high diagnostic accuracy, specificity and NPV might support its adoption to improve the diagnostic accuracy of the sentinel LN algorithm. ARTICLE HISTORY Received 10 February 2019 Accepted 30 April 2019 KEYWORDS Endometrial cancer; staging; positron emission tomography-computed tomography; lymphadenectomy Introduction Endometrial cancer (EC) is the fifth most common cancer among women worldwide. EC typically presents well or moderately differentiated endome- trioid histotype at early-stages with a prognosis usu- ally favorable [1]. Conversely, high grades histotype (grade 3 endometrioid, serous and clear-cell carcin- oma) are associated with a poorer prognosis [2]. Pelvic lymph nodes (LNs) represent the most com- mon sites of extra-uterine disease in apparent early-stage EC, and the role of lymphadenectomy in these cases has been a major controversy [3–5]. Although retrospective data suggested that systematic lymphadenectomy improves survival compared to limited lymphadenec- tomy or no sampling [6,7], the results of two random- ized controlled trials did not show any benefit in terms of disease-free and overall survival [8,9]. However, there is clear evidence supporting the assessment of LNs status to tailor the appropriate adjuvant treatment and to provide prognostic information [3–5]. Surgical staging through systematic lymphadenec- tomy or sentinel lymph node (SLN) biopsy is the standard method to assess LNs. Nevertheless, in order to reduce the short- and long-term morbidity of surgical staging other strategies have been investi- gated [3–5]. Computed tomography (CT) and mag- netic resonance imaging (MRI) have been reported to have a good sensitivity and specificity in the detection of bulky LN metastasis, but limited accuracy in LN metastases overall [10]. More recently, the hybrid positron emission tomography-computed tom- ography (PET-CT) with [18F]-Fluoro-2-Deoxy-D- Glucose (18 F-FDG) has been introduced in clinical practice during preoperative workup in selected EC patients [11–13]. We aimed to investigate the diagnostic perform- ance of PET-CT as a preoperative tool for apparent CONTACT Simone Garzon simone.garzon@univr.it Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale A. Stefani 1, 37126 Verona, Italy ß 2019 Society of Medical Innovation and Technology MINIMALLY INVASIVE THERAPY & ALLIED TECHNOLOGIES https://doi.org/10.1080/13645706.2019.1624576