{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T11:02:25Z","timestamp":1784718145117,"version":"3.55.0"},"reference-count":24,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Accurate preoperative assessment of lymph node metastasis is essential for surgical staging and treatment planning in endometrial carcinoma. Magnetic resonance imaging (MRI) is widely used for local staging; however, its nodal performance is limited by reliance on morphologic criteria. 18F-FDG PET\/CT provides whole-body functional assessment and may support decision-making when sentinel lymph node (SLN) mapping is unavailable. This study compared MRI and 18F-FDG PET\/CT for preoperative detection of pelvic and paraaortic nodal metastases across pragmatic histologic risk groups. Materials and Methods: This retrospective diagnostic-accuracy study included 255 consecutive surgically treated patients with histologically confirmed endometrial carcinoma who underwent both preoperative pelvic MRI and whole-body 18F-FDG PET\/CT at a tertiary gynecologic oncology center between December 2023 and December 2025. All patients underwent pelvic lymphadenectomy, 111 patients (43.5%) also underwent paraaortic lymphadenectomy, and SLN mapping was not performed. Patients were categorized as Group 1 (Grade 1\u20132 endometrioid adenocarcinoma) or Group 2 (Grade 3 endometrioid or non-endometrioid\/aggressive histology). Diagnostic estimates were reported with 95% confidence intervals, paired comparisons were performed using exact McNemar tests, and multivariable bias-reduced logistic regression was used to assess independent imaging associations with nodal metastasis. Results: Any nodal metastasis was documented in 24 patients (9.4%). 18F-FDG PET\/CT showed higher sensitivity than MRI for patient-level nodal detection (91.7%, 95% CI 74.2\u201397.7 vs. 37.5%, 95% CI 21.2\u201357.3), with similarly high specificity (97.0%, 95% CI 93.9\u201398.5 vs. 97.8%, 95% CI 95.0\u201399.1). The NPV of 18F-FDG PET\/CT was 99.1% (95% CI 96.8\u201399.8), compared with 93.8% (95% CI 90.0\u201396.2) for MRI. MRI sensitivity was particularly low in Group 1 (18.2%, 95% CI 5.1\u201347.7), whereas PET\/CT retained high sensitivity in both groups, though the perfect performance observed in Group 2 had wide confidence limits. Conclusions: 18F-FDG PET\/CT demonstrated superior sensitivity and NPV compared with MRI for preoperative nodal assessment in endometrial carcinoma. These results support the selective use of PET\/CT as an adjunctive staging tool in settings without SLN mapping, but they should not be interpreted as evidence that PET\/CT can replace histologic nodal staging.<\/jats:p>","DOI":"10.3390\/medicina62071418","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T09:20:39Z","timestamp":1784712039000},"page":"1418","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative Imaging for Nodal Assessment in Endometrial Carcinoma: A Comparative Study of MRI and 18F-FDG PET\/CT Across Risk Groups"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4870-2840","authenticated-orcid":false,"given":"S\u00fcleyman","family":"\u00d6zen","sequence":"first","affiliation":[{"name":"Department of Gynecologic Oncology, \u0130zmir City Hospital, \u0130zmir 35540, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1102-9741","authenticated-orcid":false,"given":"Eda G\u00fcner","family":"\u00d6zen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, \u0130zmir City Hospital, \u0130zmir 35540, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muzaffer","family":"Sanc\u0131","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, \u0130zmir City Hospital, \u0130zmir 35540, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"ref_1","first-page":"229","article-title":"Global Cancer Statistics 2022: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. 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