{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:02:28Z","timestamp":1792803748797,"version":"4.5.0"},"reference-count":32,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,19]],"date-time":"2025-07-19T00:00:00Z","timestamp":1752883200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Copenhagen and Aarhus University Hospital","id":[{"id":"https:\/\/ror.org\/040r8fr65","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Odense University Hospitals Free Research Foundation","id":[{"id":"https:\/\/ror.org\/00ey0ed83","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Odense University Hospitals Front Line Research Foundation","id":[{"id":"https:\/\/ror.org\/00ey0ed83","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Arhus University"},{"name":"Vissing Fond and Danish Cancer Research Fund"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>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\u20132023). 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\u201368) and 91% specificity (95% CI: 86\u201394). 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\u2019s Kappa \u03ba = 0.84 (95% CI: 0.73\u20130.94), the latter of which was \u2018almost perfect\u2019. 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.<\/jats:p>","DOI":"10.3390\/cancers17142396","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T07:56:14Z","timestamp":1753084574000},"page":"2396","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Diagnostic Accuracy and Interrater Agreement of FDG-PET\/CT Lymph Node Staging in High-Risk Endometrial Cancer: The SENTIREC-Endo Study"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3607-8232","authenticated-orcid":false,"given":"Jorun","family":"Holm","sequence":"first","affiliation":[{"name":"Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark"},{"name":"Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3184-3468","authenticated-orcid":false,"given":"Andr\u00e9 Henrique","family":"Dias","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, 8200 Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6335-3303","authenticated-orcid":false,"given":"Oke","family":"Gerke","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark"},{"name":"Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annika","family":"Loft","sequence":"additional","affiliation":[{"name":"Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, 2200 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten","family":"Bouchelouche","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, 8200 Aarhus, Denmark"},{"name":"Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mie Holm","family":"Vilstrup","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Esbjerg and Grindsted Hospitals, 6700 Esbjerg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah Marie","family":"Bj\u00f8rnholt","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark"},{"name":"Department of Gynecology and Obstetrics, Aarhus University Hospital, 8200 Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara Elisabeth","family":"Sponholtz","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Odense University Hospital, 5000 Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2758-9332","authenticated-orcid":false,"given":"Kirsten Marie","family":"Jochumsen","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark"},{"name":"Department of Gynecology and Obstetrics, Odense University Hospital, 5000 Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2720-9018","authenticated-orcid":false,"given":"Malene Grubbe","family":"Hildebrandt","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark"},{"name":"Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pernille Tine","family":"Jensen","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark"},{"name":"Department of Gynecology and Obstetrics, Aarhus University Hospital, 8200 Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"ASTEC Study Group, Kitchener, H., Swart, A.M.C., Qian, Q., Amos, C., and Parmar, M.K.B. (2009). Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): A randomised study. Lancet, 373, 125\u2013136.","DOI":"10.1016\/S0140-6736(08)61766-3"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"457.e1","DOI":"10.1016\/j.ajog.2008.01.010","article-title":"Is there a therapeutic impact to regional lymphadenectomy in the surgical treatment of endometrial carcinoma?","volume":"198","author":"Iasonos","year":"2008","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1097\/IGC.0000000000000510","article-title":"Impact of Lymph Node Ratio and Adjuvant Therapy in Node-Positive Endometrioid Endometrial Cancer","volume":"25","author":"Fleming","year":"2015","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12885-022-10482-x","article-title":"Recurrence and survival of patients with stage III endometrial cancer after radical surgery followed by adjuvant chemo- or chemoradiotherapy: A systematic review and meta-analysis","volume":"23","author":"Cao","year":"2023","journal-title":"BMC Cancer"},{"key":"ref_5","first-page":"CD007585","article-title":"Lymphadenectomy for the management of endometrial cancer","volume":"2017","author":"Frost","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.ejso.2012.10.011","article-title":"Complications of lymphadenectomy for gynecologic cancer","volume":"39","author":"Achouri","year":"2013","journal-title":"Eur. J. Surg. Oncol. (EJSO)"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1016\/j.jmig.2019.07.030","article-title":"Sentinel Lymph Node Mapping vs Systematic Lymphadenectomy for Endometrial Cancer: Surgical Morbidity and Lymphatic Complications","volume":"27","author":"Accorsi","year":"2020","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1097\/PGP.0000000000000463","article-title":"Sentinel Lymph Node Ultra-staging as a Supplement for Endometrial Cancer Intraoperative Frozen Section Deficiencies","volume":"38","author":"Blakely","year":"2019","journal-title":"Int. J. Gynecol. Pathol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1002\/ijgo.14923","article-title":"FIGO staging of endometrial cancer: 2023","volume":"162","author":"Berek","year":"2023","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/j.ygyno.2020.08.021","article-title":"[18F]FDG-PET or PET\/CT in the evaluation of pelvic and para-aortic lymph nodes in patients with locally advanced cervical cancer: A systematic review of the literature","volume":"159","author":"Adam","year":"2020","journal-title":"Gynecol. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.ygyno.2007.12.027","article-title":"Isolated sentinel lymph node dissection with conservative management in patients with squamous cell carcinoma of the vulva: A prospective trial","volume":"109","author":"Moore","year":"2008","journal-title":"Gynecol. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1136\/ijgc-2020-002230","article-title":"ESGO\/ESTRO\/ESP guidelines for the management of patients with endometrial carcinoma","volume":"31","author":"Concin","year":"2021","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.cpet.2014.09.007","article-title":"[18F]Fluorodeoxyglucose PET\/Computed Tomography in Breast Cancer and Gynecologic Cancers","volume":"10","author":"Hildebrandt","year":"2015","journal-title":"PET Clin."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.ejogrb.2021.01.052","article-title":"Initial experience with positron emission tomography\/computed tomography in addition to computed tomography and magnetic resonance imaging in preoperative risk assessment of endometrial cancer patients","volume":"259","author":"Nordskar","year":"2021","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1016\/j.ygyno.2021.06.018","article-title":"Sentinel lymph node mapping in early-stage cervical cancer \u2013 A national prospective multicenter study (SENTIREC trial)","volume":"162","author":"Sponholtz","year":"2021","journal-title":"Gynecol. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.ygyno.2012.11.025","article-title":"MRI, PET\/CT and ultrasound in the preoperative staging of endometrial cancer \u2014 A multicenter prospective comparative study","volume":"128","author":"Antonsen","year":"2013","journal-title":"Gynecol. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Sall\u00e9e, C., Margueritte, F., Gouy, S., Tardieu, A., Belghiti, J., Lambaudie, E., Collinet, P., Guyon, F., Legros, M., and Monteil, J. (2021). FDG-PET\/CT and Para-Aortic Staging in Endometrial Cancer. A French Multicentric Study. J. Clin. Med., 10.","DOI":"10.3390\/jcm10081746"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/s00330-022-08949-3","article-title":"Preoperative pelvic MRI and 2-[18F]FDG PET\/CT for lymph node staging and prognostication in endometrial cancer\u2014Time to revisit current imaging guidelines?","volume":"33","author":"Fasmer","year":"2022","journal-title":"Eur. Radiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1007\/s12149-011-0496-9","article-title":"Preoperative nodal staging of uterine cancer: Is contrast-enhanced PET\/CT more accurate than non-enhanced PET\/CT or enhanced CT alone?","volume":"25","author":"Kitajima","year":"2011","journal-title":"Ann. Nucl. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s11912-016-0506-0","article-title":"What Is the Best Preoperative Imaging for Endometrial Cancer?","volume":"18","author":"Haldorsen","year":"2016","journal-title":"Curr. Oncol. Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.ygyno.2024.01.049","article-title":"Identifying safe diagnostic algorithms for sentinel lymph node mapping in high-risk endometrial cancer: The SENTIREC-endo study","volume":"182","author":"Mogensen","year":"2024","journal-title":"Gynecol. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1002\/(SICI)1097-0258(19980430)17:8<857::AID-SIM777>3.0.CO;2-E","article-title":"Two-sided confidence intervals for the single proportion: Comparison of seven methods","volume":"17","author":"Newcombe","year":"1998","journal-title":"Stat Med"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1007\/s00259-014-2961-x","article-title":"FDG PET\/CT: EANM procedure guidelines for tumour imaging: Version 2.0","volume":"42","author":"Boellaard","year":"2015","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1093\/biomet\/68.3.589","article-title":"Nonparametric Estimates of Standard Error: The Jackknife, the Bootstrap and Other Methods","volume":"68","author":"Efron","year":"1981","journal-title":"Biometrika"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1002\/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3","article-title":"Index for rating diagnostic tests","volume":"3","author":"Youden","year":"1950","journal-title":"Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.jclinepi.2010.03.002","article-title":"Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed","volume":"64","author":"Kottner","year":"2011","journal-title":"J. Clin. Epidemiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2307\/2529310","article-title":"The Measurement of Observer Agreement for Categorical Data","volume":"33","author":"Landis","year":"1977","journal-title":"Biometrics"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1001\/jamasurg.2020.5060","article-title":"Assessment of Sentinel Lymph Node Biopsy vs Lymphadenectomy for Intermediate- and High-Grade Endometrial Cancer Staging","volume":"156","author":"Cusimano","year":"2021","journal-title":"JAMA Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"367.e1","DOI":"10.1016\/j.ajog.2021.05.034","article-title":"Sentinel lymph node biopsy in high-grade endometrial cancer: A systematic review and meta-analysis of performance characteristics","volume":"225","author":"Marchocki","year":"2021","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.ygyno.2012.06.035","article-title":"Prospective assessment of survival, morbidity, and cost associated with lymphadenectomy in low-risk endometrial cancer","volume":"127","author":"Dowdy","year":"2012","journal-title":"Gynecol. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Menendez-Santos, M., Gonzalez-Baerga, C., Taher, D., Waters, R., Virarkar, M., and Bhosale, P. (2024). Endometrial Cancer: 2023 Revised FIGO Staging System and the Role of Imaging. Cancers, 16.","DOI":"10.3390\/cancers16101869"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1007\/s00259-017-3853-7","article-title":"EANM\/EARL FDG-PET\/CT accreditation\u2014Summary results from the first 200 accredited imaging systems","volume":"45","author":"Kaalep","year":"2018","journal-title":"Eur. J. Nucl. Med."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/14\/2396\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:12:36Z","timestamp":1760033556000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/14\/2396"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,19]]},"references-count":32,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["cancers17142396"],"URL":"https:\/\/doi.org\/10.3390\/cancers17142396","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,19]]}}}