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Diagnostic Value of 18F-FDG PET/CT and MRI in the Preoperative Evaluation of Uterine Carcinosarcoma

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Abstract

Purpose

This study aimed to compare the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) and magnetic resonance imaging (MRI) in the preoperative evaluation of uterine carcinosarcoma.

Methods

Fifty-four women with pathologically confirmed uterine carcinosarcoma who underwent preoperative FDG PET/CT and MRI from June 2006 to November 2016 were included. Pathologic findings from primary tumor lesions, para-aortic and pelvic lymph node (LN) areas, and peritoneal seeding lesions were compared with the FDG PET/CT and MRI findings. The maximum standardized uptake value (SUVmax) of the primary tumor and LN was obtained. The tumor-to-liver ratio (TLR) was calculated by dividing the SUVmax of the primary tumor or LN by the mean SUV of the liver.

Results

For detecting primary tumor lesions (n = 54), the sensitivity and accuracy of FDG PET/CT (53/54) and MRI (53/54) were 98.2%. The sensitivity, specificity, and accuracy of FDG PET/CT versus MRI were as follows: 63.2% (12/19) versus 26.3% (5/19), 100% (35/35) versus 100% (35/35), and 87.0% versus 74.0%, respectively, for pelvic LN areas (p = 0.016); 85.7% (12/14) versus 42.9% (6/14), 90% (36/40) versus 97.5% (39/40), and 88.9% versus 83.3%, respectively, for para-aortic LN areas (p = 0.004); and 59.4% (19/32) versus 50% (16/32), 100% (22/22) versus 100% (22/22), and 75.9% versus 70.4%, respectively, for peritoneal seeding lesions (p = 0.250). For distant metastasis, the sensitivity, specificity, and accuracy of FDG PET/CT were 100 (8/8), 97.8 (45/46), and 98.2%, respectively.

Conclusions

FDG PET/CT showed superior diagnostic accuracy compared to MRI in detecting pelvic and para-aortic LN metastasis in patients with uterine carcinosarcoma. Moreover, FDG PET/CT facilitated the identification of distant metastasis.

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References

  1. Cantrell LA, Blank SV, Duska LR. Uterine carcinosarcoma: a review of the literature. Gynecol Oncol. 2015;137:581–8.

    Article  Google Scholar 

  2. Artioli G, Wabersich J, Ludwig K, Gardiman MP, Borgato L, Garbin F. Rare uterine cancer: carcinosarcomas. Review from histology to treatment. Crit Rev Oncol Hematol. 2015;94:98–104.

    Article  Google Scholar 

  3. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64:9–29.

    Article  Google Scholar 

  4. Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009;105:103–4.

    Article  Google Scholar 

  5. Bansal N, Herzog TJ, Seshan VE, Schiff PB, Burke WM, Cohen CJ, et al. Uterine carcinosarcomas and grade 3 endometrioid cancers: evidence for distinct tumor behavior. Obstet Gynecol. 2008;112:64–70.

    Article  Google Scholar 

  6. Menczer J. Review of recommended treatment of uterine carcinosarcoma. Curr Treat Options in Oncol. 2015;16:53.

    Article  Google Scholar 

  7. Gokce ZK, Turan T, Karalok A, Tasci T, Ureyen I, Ozkaya E, et al. Clinical outcomes of uterine carcinosarcoma: results of 94 patients. Int J Gynecol Cancer. 2015;25:279–87.

    Article  Google Scholar 

  8. Huang YT, Chang CB, Yeh CJ, Lin G, Huang HJ, Wang CC, et al. Diagnostic accuracy of 3.0 T diffusion-weighted MRI for patients with uterine carcinosarcoma: assessment of tumor extent and lymphatic metastasis. J Magn Reson Imaging. 2018.

  9. Lee HJ, Park JY, Lee JJ, Kim MH, Kim DY, Suh DS, et al. Comparison of MRI and 18F-FDG PET/CT in the preoperative evaluation of uterine carcinosarcoma. Gynecol Oncol. 2016;140:409–14.

    Article  Google Scholar 

  10. Ho KC, Lai CH, Wu TI, Ng KK, Yen TC, Lin G, et al. 18F-fluorodeoxyglucose positron emission tomography in uterine carcinosarcoma. Eur J Nucl Med Mol Imaging. 2008;35:484–92.

    Article  Google Scholar 

  11. Chen F, Yu C, You X, Mi B, Wan W. Carcinosarcoma of the uterine corpus on 18F-FDG PET/CT in a postmenopausal woman with elevated AFP. Clin Nucl Med. 2014;39:803–5.

    Article  Google Scholar 

  12. Lee HJ, Lee JJ, Park JY, Kim JH, Kim YM, Kim YT, et al. Prognostic value of metabolic parameters determined by preoperative (1)(8)F-FDG PET/CT in patients with uterine carcinosarcoma. J Gynecol Oncol. 2017;e43:28.

    Google Scholar 

  13. Lin G, Ho KC, Wang JJ, Ng KK, Wai YY, Chen YT, et al. Detection of lymph node metastasis in cervical and uterine cancers by diffusion-weighted magnetic resonance imaging at 3 T. J Magn Reson Imaging. 2008;28:128–35.

    Article  Google Scholar 

  14. Nemani D, Mitra N, Guo M, Lin L. Assessing the effects of lymphadenectomy and radiation therapy in patients with uterine carcinosarcoma: a SEER analysis. Gynecol Oncol. 2008;111:82–8.

    Article  Google Scholar 

  15. Arend R, Doneza JA, Wright JD. Uterine carcinosarcoma. Curr Opin Oncol. 2011;23:531–6.

    PubMed  Google Scholar 

  16. Koh WJ, Abu-Rustum NR, Bean S, Bradley K, Campos SM, Cho KR, et al. Uterine neoplasms. Version 1.2018. NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw. 2018;16:170–99.

    Article  Google Scholar 

  17. Kim HJ, Cho A, Yun M, Kim YT, Kang WJ. Comparison of FDG PET/CT and MRI in lymph node staging of endometrial cancer. Ann Nucl Med. 2016;30:104–13.

    Article  Google Scholar 

  18. Park JY, Kim EN, Kim DY, Suh DS, Kim JH, Kim YM, et al. Comparison of the validity of magnetic resonance imaging and positron emission tomography/computed tomography in the preoperative evaluation of patients with uterine corpus cancer. Gynecol Oncol. 2008;108:486–92.

    Article  Google Scholar 

  19. Reinhardt MJ, Ehritt-Braun C, Vogelgesang D, Ihling C, Hogerle S, Mix M, et al. Metastatic lymph nodes in patients with cervical cancer: detection with MR imaging and FDG PET. Radiology. 2001;218:776–82.

    Article  CAS  Google Scholar 

  20. Sagae S, Yamashita K, Ishioka S, Nishioka Y, Terasawa K, Mori M, et al. Preoperative diagnosis and treatment results in 106 patients with uterine sarcoma in Hokkaido, Japan. Oncology. 2004;67:33–9.

    Article  Google Scholar 

  21. Temkin SM, Hellmann M, Lee YC, Abulafia O. Early-stage carcinosarcoma of the uterus: the significance of lymph node count. Int J Gynecol Cancer. 2007;17:215–9.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea

    Soyoung Kim & Won Jun Kang

  2. Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea

    Young Tae Kim, Sunghoon Kim, Sang Wun Kim & Jung-Yun Lee

Authors
  1. Soyoung Kim
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  2. Young Tae Kim
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  3. Sunghoon Kim
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  4. Sang Wun Kim
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  5. Jung-Yun Lee
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Corresponding author

Correspondence to Won Jun Kang.

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Conflict of Interest

Won Jun Kang declares that this research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI17C1491) and the National Research Foundation of Korea(NRF) grant funded by the Korea government(MSIT) (No. 2018004651). Soyoung Kim, Young Tae Kim, Sunghoon Kim, Sang Wun Kim, and Jung-Yun Lee declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

The institutional review board of our institute approved this retrospective study, and the requirement to obtain informed consent was waived.

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Kim, S., Kim, Y.T., Kim, S. et al. Diagnostic Value of 18F-FDG PET/CT and MRI in the Preoperative Evaluation of Uterine Carcinosarcoma. Nucl Med Mol Imaging 52, 445–452 (2018). https://doi.org/10.1007/s13139-018-0549-2

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  • DOI: https://doi.org/10.1007/s13139-018-0549-2

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