{"doi":"10.3390/cancers17142396","title":"Diagnostic Accuracy and Interrater Agreement of FDG-PET/CT Lymph Node Staging in High-Risk Endometrial Cancer: The SENTIREC-Endo Study","abstract":"<b>Background/Objectives:</b> 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. <b>Methods:</b> 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. <b>Results:</b> 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'. <b>Conclusions:</b> 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.","journal":"Cancers","year":2025,"id":4290,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.0438,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-07-19","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":44498,"name":"André Henrique Dias","orcid":"0000-0003-3184-3468","position":1,"is_corresponding":false},{"id":44499,"name":"Oke Gerke","orcid":"0000-0001-6335-3303","position":2,"is_corresponding":false},{"id":44500,"name":"Annika Loft","orcid":null,"position":3,"is_corresponding":false},{"id":44501,"name":"Kirsten Bouchelouche","orcid":"0000-0002-6900-8794","position":4,"is_corresponding":false},{"id":44502,"name":"Mie Holm Vilstrup","orcid":"0000-0002-4760-0068","position":5,"is_corresponding":false},{"id":44503,"name":"Sarah Marie Bjørnholt","orcid":"0000-0001-9654-7876","position":6,"is_corresponding":false},{"id":44504,"name":"Sara Elisabeth Sponholtz","orcid":null,"position":7,"is_corresponding":false},{"id":44505,"name":"Kirsten Marie Jochumsen","orcid":"0000-0002-2758-9332","position":8,"is_corresponding":false},{"id":44506,"name":"Malene Grubbe Hildebrandt","orcid":"0000-0003-2720-9018","position":9,"is_corresponding":false},{"id":44507,"name":"Pernille Tine Jensen","orcid":"0000-0002-1637-6040","position":10,"is_corresponding":false},{"id":44497,"name":"Jorun Holm","orcid":"0000-0003-3607-8232","position":0,"is_corresponding":true}],"reference_count":32,"raw_metadata":null,"created_at":"2026-03-01T18:20:47.508186Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}