18F-FDG PET in the management of endometrial cancer

  • Angel Chao
  • Ting-Chang Chang
  • Koon-Kwan Ng
  • Swei Hsueh
  • Huei-Jean Huang
  • Hung-Hsueh Chou
  • Chien-Sheng Tsai
  • Tzu-Chen Yen
  • Tzu-I Wu
  • Chyong-Huey LaiEmail author
Original Article



Few studies have investigated the clinical impact of whole-body positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) in endometrial cancer. We aimed to assess the value of integrating FDG-PET into the management of endometrial cancer in comparison with conventional imaging alone.


All patients with histologically confirmed primary advanced (stage III/IV) or suspicious/documented recurrent endometrial cancer, with poor prognostic features (serum CA-125 >35 U/ml or unfavourable cell types), or surveillance after salvage therapy were eligible. Before FDG-PET scanning, each patient had received magnetic resonance imaging and/or computed tomography (MRI-CT). The receiver operating characteristic curve method with calculation of the area under the curve (AUC) was used to compare the diagnostic efficacy. Clinical impacts were determined on a scan basis.


Forty-nine eligible patients were accrued and 60 studies were performed (27 primary staging, 33 post-therapy surveillance or restaging on relapse). The clinical impact was positive in 29 (48.3%) of the 60 scans. Mean standardised uptake values (SUVs) of true-positive lesions were 13.2 (range 5.7–37.4) for central pelvic lesions and 11.1 (range 1.5–37.4) for metastases. The sensitivity of FDG-PET alone (P<0.0001) or FDG-PET plus MRI-CT (P<0.0001) was significantly higher than that of MRI-CT alone in overall lesion detection. FDG-PET plus MRI-CT was significantly superior to MRI-CT alone in overall lesion detection (AUC 0.949 vs 0.872; P=0.004), detection of pelvic nodal/soft tissue metastases (P=0.048) and detection of extrapelvic metastases (P=0.010), while FDG-PET alone was only marginally superior by AUC (P=0.063).


Whole-body FDG-PET coupled with MRI-CT facilitated optimal management of endometrial cancer in well-selected cases.


18F-FDG PET Endometrial cancer Primary staging Recurrence Salvage therapy 



This study was supported by grant CMRPG32022 from Chang Gung Memorial Hospital and grant NSC-93-NU-7-182-003 from the National Science Council and the Institute of Nuclear Energy Research, Taiwan.


  1. 1.
    Morrow CP, Bundy BN, Kurman RJ, Creasman WT, Heller P, Homesley HD, et al. Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecol Oncol 1991;40:55–65CrossRefPubMedGoogle Scholar
  2. 2.
    Irvin WP, Rice LW, Berkowitz RS. Advances in the management of endometrial adenocarcinoma. A review. J Reprod Med 2002;47:173–189; discussion 189–90PubMedGoogle Scholar
  3. 3.
    Aalders JG, Abeler V, Kolstad P. Recurrent adenocarcinoma of the endometrium: a clinical and histopathological study of 379 patients. Gynecol Oncol 1984;17:85–103CrossRefPubMedGoogle Scholar
  4. 4.
    Kao MS. Management of recurrent endometrial cancer. Chang Gung Med J 2004;27:639–45PubMedGoogle Scholar
  5. 5.
    Sears JD, Greven KM, Hoen HM, Randall ME. Prognostic factors and treatment outcome for patients with locally recurrent endometrial cancer. Cancer 1994;74:1303–8PubMedGoogle Scholar
  6. 6.
    Jeyarajah AR, Gallagher CJ, Blake PR, Oram DH, Dowsett M, Fisher C, et al. Long-term follow-up of gonadotrophin-releasing hormone analog treatment for recurrent endometrial cancer. Gynecol Oncol 1996;63:47–52CrossRefPubMedGoogle Scholar
  7. 7.
    Moore TD, Phillips PH, Nerenstone SR, Cheson BD. Systemic treatment of advanced and recurrent endometrial carcinoma: current status and future directions. J Clin Oncol 1991;9:1071–88PubMedGoogle Scholar
  8. 8.
    Huang HJ, Lai CH, Tsai CS, Ng KK, Lin CT. Radical resection and intraoperative radiotherapy for a recurrent endometrial cancer after prolonged remission following aggressive salvage therapy: case report. Chang Gung Med J 1999;22:654–9Google Scholar
  9. 9.
    Manfredi R, Mirk P, Maresca G, Margariti PA,Testa A, Zannoni GF, et al. Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planning. Radiology 2004;231:372–8PubMedGoogle Scholar
  10. 10.
    Frei KA, Kinkel K, Bonel HM, Lu Y, Zaloudek C, Hricak H. Prediction of deep myometrial invasion in patients with endometrial cancer: clinical utility of contrast-enhanced MR imaging—a meta-analysis and Bayesian analysis. Radiology 2000;216:444–9PubMedGoogle Scholar
  11. 11.
    Duk JM, Aalders JG, Fleuren GJ, de Bruijn HW. CA 125: a useful marker in endometrial carcinoma. Am J Obstet Gynecol 1986;155:1097–102PubMedGoogle Scholar
  12. 12.
    Patsner B, Mann WJ. The value of preoperative serum CA 125 levels in patients with a pelvic mass. Am J Obstet Gynecol 1988;159:873–6PubMedGoogle Scholar
  13. 13.
    Dotters DJ. Preoperative CA 125 in endometrial cancer: is it useful? Am J Obstet Gynecol 2000;182:1328–34CrossRefPubMedGoogle Scholar
  14. 14.
    Yen TC, Ng KK, Ma SY, Chou HH, Tsai CS, Hsueh S, et al. Value of dual-phase 2-fluoro-2-deoxy-d-glucose positron emission tomography in cervical cancer. J Clin Oncol 2003;21:3651–8CrossRefPubMedGoogle Scholar
  15. 15.
    Lai CH, Huang KG, See LC, Yen TC, Tsai CS, Chang TC, et al. Restaging of recurrent cervical carcinoma with dual-phase [18F]fluoro-2-deoxy-d-glucose positron emission tomography. Cancer 2004;100:544–52CrossRefPubMedGoogle Scholar
  16. 16.
    Grigsby PW, Siegel BA, Dehdashti F. Lymph node staging by positron emission tomography in patients with carcinoma of the cervix. J Clin Oncol 2001;19:3745–9PubMedGoogle Scholar
  17. 17.
    Rose PG, Adler LP, Rodriguez M, Faulhaber PF, Abdul-Karim FW, Miraldi F. Positron emission tomography for evaluating para-aortic nodal metastasis in locally advanced cervical cancer before surgical staging: a surgicopathologic study. J Clin Oncol 1999;17:41–5PubMedGoogle Scholar
  18. 18.
    Zimny M, Siggelkow W, Schroder W, Nowak B, Biemann S, Rath W, et al. 2-[Fluorine-18]-fluoro-2-deoxy-d-glucose positron emission tomography in the diagnosis of recurrent ovarian cancer. Gynecol Oncol 2001;83:310–5CrossRefPubMedGoogle Scholar
  19. 19.
    Belhocine T, De Barsy C, Hustinx R, Willems-Foidart J. Usefulness of 18F-FDG PET in the post-therapy surveillance of endometrial carcinoma. Eur J Nucl Med Mol Imaging 2002;29:1132–9CrossRefPubMedGoogle Scholar
  20. 20.
    Saga T, Higashi T, Ishimori T, Mamede M, Nakamoto Y, Mukai T, et al. Clinical value of FDG-PET in the follow up of post-operative patients with endometrial cancer. Ann Nucl Med 2003;17:197–203PubMedGoogle Scholar
  21. 21.
    Nakahara T, Fujii H, Ide M, Mochizuki Y, Takahashi W, Yasuda S, et al. F-18 FDG uptake in endometrial cancer. Clin Nucl Med 2001;26:82–3CrossRefPubMedGoogle Scholar
  22. 22.
    Lentz SS. Endometrial carcinoma diagnosed by positron emission tomography: a case report. Gynecol Oncol 2002;86:223–4CrossRefPubMedGoogle Scholar
  23. 23.
    Horowitz NS, Dehdashti F, Herzog TJ, Rader JS, Powell MA, Gibb RK, et al. Prospective evaluation of FDG-PET for detecting pelvic and para-aortic lymph node metastasis in uterine corpus cancer. Gynecol Oncol 2004;101:164–71Google Scholar
  24. 24.
    Mariani A, Webb MJ, Keeney GL, Calori G, Podratz KC. Role of wide/radical hysterectomy and pelvic lymph node dissection in endometrial cancer with cervical involvement. Gynecol Oncol 2001;83:72–80CrossRefPubMedGoogle Scholar
  25. 25.
    Larson DM, Broste SK, Krawisz BR. Surgery without radiotherapy for primary treatment of endometrial cancer. Obstet Gynecol 1998;91:355–9CrossRefPubMedGoogle Scholar
  26. 26.
    Dorfman RE, Alpern MB, Gross BH, Sandler MA. Upper abdominal lymph nodes: criteria for normal size determined with CT. Radiology 1991;180:319–22PubMedGoogle Scholar
  27. 27.
    Lerman H, Metser U, Grisaru D, Fishman A, Lievshitz G, Even-Sapir E. Normal and abnormal 18F-FDG endometrial and ovarian uptake in pre- and postmenopausal patients: assessment by PET/CT. J Nucl Med 2004;45:266–71PubMedGoogle Scholar
  28. 28.
    Torizuka T, Kanno T, Futatsubashi M, Okada H, Yoshikawa E, Nakamura F, et al. Imaging of gynecologic tumors: comparison of 11C-choline PET with 18F-FDG PET. J Nucl Med 2003;44:1051–6PubMedGoogle Scholar
  29. 29.
    Morris M, Alvarez RD, Kinney WK, Wilson TO. Treatment of recurrent adenocarcinoma of the endometrium with pelvic exenteration. Gynecol Oncol 1996;60:288–91CrossRefPubMedGoogle Scholar
  30. 30.
    Barakat RR, Goldman NA, Patel DA, Venkatraman ES, Curtin JP. Pelvic exenteration for recurrent endometrial cancer. Gynecol Oncol 1999;75:99–102CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Angel Chao
    • 1
    • 2
  • Ting-Chang Chang
    • 1
  • Koon-Kwan Ng
    • 3
  • Swei Hsueh
    • 4
  • Huei-Jean Huang
    • 1
  • Hung-Hsueh Chou
    • 1
  • Chien-Sheng Tsai
    • 5
  • Tzu-Chen Yen
    • 6
  • Tzu-I Wu
    • 1
  • Chyong-Huey Lai
    • 1
    • 7
    Email author
  1. 1.Division of Gynecologic Oncology, Department of Obstetrics and GynecologyChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
  2. 2.Graduate Institute of Clinical Medical SciencesChang Gung UniversityTaoyuanTaiwan
  3. 3.Department of RadiologyChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
  4. 4.Department of PathologyChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
  5. 5.Department of Radiation OncologyChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
  6. 6.Department of Nuclear MedicineChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
  7. 7.Department of Obstetrics and GynecologyChang Gung Memorial Hospital Linkou Medical CenterTaoyuanTaiwan

Personalised recommendations