Background/Objectives:The SENTIREC-endo study identified a safe sentinel lymph node mapping algorithm combined with PET-positive node dissection, matching radical pelvic and paraaortic lymphadenectomy in high-risk endometrial cancer. The present study evaluated the diagnostic accuracy of FDG-PET/CT for lymph node metastases in the same population based on location, size, and Standardised Uptake Value (SUV), in addition to assessing interrater agreement across three Danish centres.Methods:This prospective multicentre study included women with high-risk endometrial cancer from the Danish SENTIREC study database (2017–2023). All patients underwent preoperative FDG-PET/CT. Diagnostic accuracy was evaluated against a pathology-confirmed reference standard. Interrater agreement was evaluated between trained specialists in Nuclear Medicine.Results:Among 227 patients, 52 patients (23%) had lymph node metastases. FDG-PET/CT identified lymph node metastases with 56% sensitivity (95% CI: 42–68) and 91% specificity (95% CI: 86–94). Positive and negative predictive values were 64% and 87%, respectively. Specificity for paraaortic nodes was high (97%), though sensitivity remained limited (56%). Lymph node size and SUVmax had moderate diagnostic value (AUC-ROC ~0.7). Interrater proportion of agreement was 95% and Cohen’s Kappa κ = 0.84 (95% CI: 0.73–0.94), the latter of which was ‘almost perfect’.Conclusions:FDG-PET/CT had limited sensitivity in lymph node staging in high-risk EC, and the diagnostic accuracy of FDG-PET/CT remains complementary to the sentinel node procedure. Due to its high specificity and strong interrater reliability, FDG-PET/CT is recommended for clinical implementation in combination with the sensitive sentinel node biopsy for the targeted dissection of PET-positive lymph nodes, particularly in paraaortic regions.
背景/目的：SENTIREC-endo研究确立了一种结合PET阳性淋巴结清扫的前哨淋巴结定位安全算法，其在高危子宫内膜癌中的效果与根治性盆腔及腹主动脉旁淋巴结清扫术相当。本研究基于同一患者群体，除评估丹麦三家中心间阅片者一致性外，进一步从位置、大小及标准化摄取值（SUV）角度，评估了FDG-PET/CT对淋巴结转移的诊断准确性。 方法：这项前瞻性多中心研究纳入丹麦SENTIREC研究数据库（2017–2023年）中的高危子宫内膜癌女性患者。所有患者均接受术前FDG-PET/CT检查。诊断准确性以病理学确诊结果为金标准进行评估。阅片者间一致性由经过培训的核医学专科医师进行评价。 结果：在227例患者中，52例（23%）存在淋巴结转移。FDG-PET/CT检测淋巴结转移的敏感性为56%（95% CI：42–68），特异性为91%（95% CI：86–94）。阳性预测值和阴性预测值分别为64%和87%。对腹主动脉旁淋巴结的特异性较高（97%），但敏感性仍有限（56%）。淋巴结大小与SUVmax具有中等诊断价值（AUC-ROC约0.7）。阅片者间一致率为95%，Cohen's Kappa κ = 0.84（95% CI：0.73–0.94），后者达到“几乎完全一致”水平。 结论：FDG-PET/CT在高危子宫内膜癌淋巴结分期中敏感性有限，其诊断准确性仍作为前哨淋巴结活检的补充手段。鉴于其高特异性及强阅片者间可靠性，建议在临床实践中将FDG-PET/CT与敏感的前哨淋巴结活检联合应用，以实现对PET阳性淋巴结（尤其是腹主动脉旁区域）的靶向清扫。
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