Endometrial cancer 

            Female, 64 year old, endometrial cancer IV operated on, under therapy with chemotherapy 2nd line with AC, and currently after 6th cycle. New lung nodule 6 mm in left lung although diminution of  retroperitoneal lymphnodes at previous staging. At recent control, lung nodule augmented from 7 mm to 19-mm, without other new lesions. Patient asymptomatic. Metastasectomy was considered. PET showed lung mass suv  23.5 (left side, yellow arrow). Retroperitoneal nodes with SUV  less than 3 and left adrenal nodule  with SUV 3.5. Retrospectively,  adrenal node was present on CT a year ago and so resection of solitary metastasis was decided. Fusion PET-CT on the right depicts mild abdominal uptake and prominent ureter dilation remaining from previous surgery in the primary tumor (right side, yellow arrow).

            According to Kazuhiro et al. node-based sensitivity, specificity, and accuracy of PET/CT for detecting nodal metastases were 53%, 99% and 98%, respectively.

              The sensitivity for detecting metastatic lesions 4 mm or less in diameter was 17%, that for lesions between 5 and 9 mm was 67%, and that for lesions 10 mm or larger was 93%.

            The overall patient-based sensitivity, specificity, and accuracy were 50%, 87%, and 78%, respectively.

            Out of 40 patients, the histologic subtypes were endometrioid adenocarcinoma in 37 cases, serous papillary carcinoma in one, clear cell carcinoma in one, and adenosquamous cell carcinoma in one.

              Integrated FDG PET/CT is superior to conventional imaging techniques, but only moderately sensitive to detect lymph node metastasis and should not replace lymphadenectomy.
 

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