What question did this study set out to answer?

The aim is to assess the diagnostic accuracy of [18F]FDG PET/MRI for staging endometrial cancer and predicting its aggressiveness and recurrence.

January 18, 2026Open Access

18FFDG PET/MRI in Endometrial Cancer: Prospective Evaluation of Preoperative Staging, Molecular Characterization and Prognostic Assessment

Key Points

The aim is to assess the diagnostic accuracy of [18F]FDG PET/MRI for staging endometrial cancer and predicting its aggressiveness and recurrence.
Evaluated patients with endometrial cancer undergoing [18F]FDG PET/MRI before surgery.
Utilized histology, immunohistochemistry, and follow-up as reference standards.
Reviewed imaging modalities separately for diagnostic metrics (ACC, SN, SP, PPV, NPV).
Applied statistical analyses including Spearman’s correlations and ROC-AUC.
[18F]FDG PET/MRI achieved 98.75% accuracy and sensitivity for primary tumor detection.
For lymph node detection, it showed 92.41% accuracy and 84.62% sensitivity.
Predictive values for lymph node involvement and deep myometrial invasion were notable at AUC values ranging from 71.47% to 82.00%.
Tumor size and metabolic tumor volume significantly correlated with increased recurrence likelihood.

Abstract

Background/Objectives: Early and accurate characterization of endometrial cancer (EC) is crucial for patient management, but current imaging modalities lack in diagnostic accuracy and ability to assess molecular profiles. The aim of this study is to evaluate hybrid 18FFDG PET/MRI’s diagnostic accuracy in EC staging and role in predicting tumor aggressiveness, molecular characterization, and recurrence. Methods: A prospective study (ClinicalTrials.gov, ID:NCT04212910) evaluating EC patients undergoing 18FFDG PET/MRI before surgery (2018–2024). Histology, immunohistochemistry, and patients’ follow-up (mean FU time: 3.13y) were used as the reference standard. 18FFDG PET/MRI, PET only, and MRI only were independently reviewed to assess the diagnostic accuracy (ACC), sensitivity (SN), specificity (SP), and positive/negative predictive value (PPV, NPV). Imaging parameters were extracted from 18FFDG PET and pcT1w, T2w, DWI, and DCE MRI. Spearman’s correlations, Fisher’s exact test, ROC-AUC analysis, Kaplan–Meier survival curves, log-rank tests and Cox proportional hazards models were applied. Results: Eighty participants with primary EC (median age 63 ± 12 years) were enrolled, with 17% showing LN involvement. 18FFDG PET/MRI provided ACC = 98.75%, SN = 98.75%, and PPV = 100% for primary tumor detection, and ACC = 92.41%, SN = 84.62%, SP = 93.94%, PPV = 73.33%, and NPV = 96.88% for LN detection. PET/MRI parameters predicted LN involvement (AUC = 79.49%), deep myometrial invasion (79.78%), lymphovascular space invasion (82.00%), p53abn (71.47%), MMRd (74.51%), relapse (82.00%), and postoperative administration of adjuvant therapy (79.64%). Patients with a tumor cranio-caudal diameter ≥ 43 mm and MTV ≥ 13.5 cm3 showed increased probabilities of recurrence (p < 0.001). Conclusions: 18FFDG PET/MR showed exceptional accuracy in EC primary tumor and LN detection. Derived parameters demonstrated potential ability in defining features of aggressiveness, molecular alterations, and tumor recurrence.

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Cite This Study

Bezzi et al. (Fri,) studied this question.

synapsesocial.com/papers/696c772aeb60fb80d1395690 https://doi.org/https://doi.org/10.3390/cancers18020280

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