Enhancing Lymph Node Staging in High-Risk Endometrial Cancer with FDG-PET/CT

Accurate lymph node staging in high-risk endometrial cancer directly influences prognosis and treatment pathways, yet CT and MRI often leave clinicians navigating blind spots.

Precise delineation of nodal involvement shapes decisions on the extent of surgical staging and adjuvant therapy, particularly as the incidence of advanced-stage disease rises. FDG-PET/CT has emerged as a molecular imaging tool with the potential to enhance diagnostic accuracy and guide personalized interventions. Recent data from the SENTIREC-Endo study reveal that this modality achieves a specificity of 94.3% for lymph node detection, offering a reliable confirmation of metastatic spread in patients at greatest risk.

This challenge is compounded by variable interpretation of metabolic activity across centers. Earlier findings suggest that interrater agreement in FDG-PET/CT interpretation is substantial, with a kappa coefficient of 0.75, indicating consistent performance among nuclear medicine specialists and radiologists. Standardizing image acquisition and reporting protocols may further mitigate discrepancies, while emerging AI-driven platforms promise to refine lesion segmentation and uptake quantification within a model that tailors treatment to individual patient profiles.

Incorporating these insights into multidisciplinary tumor boards transforms preoperative planning. High-specificity FDG-PET/CT findings can reduce unnecessary lymphadenectomies and focus surgical effort on true-positive nodes; however, considering both specificity and sensitivity is important as they guide management decisions. This report underscores the value of integrating metabolic imaging into risk-adapted treatment algorithms, enhancing both the accuracy and efficacy of surgical and adjuvant strategies.

Key Takeaways:

• FDG-PET/CT shows high specificity and reliability in lymph node staging for high-risk endometrial cancer, offering a robust diagnostic tool.
• Substantial interrater reliability underscores its consistent performance across varied clinical settings, supporting reproducible outcomes.
• Integrating FDG-PET/CT into treatment planning can enhance accuracy, personalize management, and reduce unnecessary procedures, reflecting significant clinical improvements.