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Preoperative risk stratification using metabolic parameters of 18F-FDG PET/CT in patients with endometrial cancer

  • Kazuhiro KitajimaEmail author
  • Yuko Suenaga
  • Yoshiko Ueno
  • Tetsuo Maeda
  • Yasuhiko Ebina
  • Hideto Yamada
  • Takashi Okunaga
  • Kazuhiro Kubo
  • Keitarou Sofue
  • Tomonori Kanda
  • Yukihisa Tamaki
  • Kazuro Sugimura
Original Article

Abstract

Purpose

To evaluate the usefulness of metabolic parameters obtained by 18F-FDG PET/CT for preoperative stratification of high-risk and low-risk endometrial carcinomas.

Methods

Preoperative 18F-FDG PET/CT was performed in 56 women with endometrial cancer. Maximum standardized uptake values (SUVmax), metabolic tumour volume (MTV) and total lesion glycolysis (TLG) of primary tumours were compared with clinicopathological features of surgical specimens. Diagnostic performance in terms of differentiation of low-risk disease (endometrioid histology, histological grade 1 or 2, invasion of less than half of the myometrium, and FIGO stage I) from high-risk disease was assessed.

Results

MTV and TLG were significantly higher in patients with higher histological grade (p = 0.0026 and p = 0.034), larger tumour size (p = 0.002 and p = 0.0017), lymphovascular space involvement (LVSI; p = 0.012 and p = 0.0051), myometrial invasion (p = 0.027 and p = 0.031), cervical stromal invasion (p = 0.023 and p = 0.014), ovarian metastasis (p = 0.00022 and p = 0.00034), lymph node metastasis (p < 0.0001 and p < 0.0001), and higher FIGO stage (p = 0.0011 and p = 0.00048). SUVmax was significantly higher in patients with larger tumour size (p = 0.0025), LVSI (p = 0.00023) and myometrial invasion (p < 0.0001). The areas under the ROC curves (AUCs) for distinguishing high-risk from low-risk carcinoma were 0.625, 0.829 and 0.797 for SUVmax, MTV and TLG, respectively. AUCs for both MTV and TLG were significantly larger than that for SUVmax (p = 0.0049 and p = 0.021). The optimal TLG cut-off value of 70.2, determined by ROC analysis, was found to have 72.0 % sensitivity and 74.2 % specificity for risk stratification.

Conclusion

MTV and TLG of primary endometrial cancer show better correlations with clinicopathological features and are more useful for differentiating high-risk from low-risk carcinoma than SUVmax.

Keywords

FDG PET/CT Endometrial cancer SUVmax MTV TLG 

Notes

Compliance with ethical standards

Conflicts of interest

None.

Research involving human participants and/or animals

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.

This article does not contain any studies with animals performed by any of the authors.

Informed consent

This retrospective study was approved by the institutional review board, and the need for patient informed consent was waived.

Acknowledgments

We wish to express special thanks to Hirofumi R.T. Kawakami (GE healthcare) for his outstanding technical assistance.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Kazuhiro Kitajima
    • 1
    • 6
    Email author
  • Yuko Suenaga
    • 1
  • Yoshiko Ueno
    • 1
  • Tetsuo Maeda
    • 1
  • Yasuhiko Ebina
    • 2
  • Hideto Yamada
    • 2
  • Takashi Okunaga
    • 3
  • Kazuhiro Kubo
    • 3
  • Keitarou Sofue
    • 1
  • Tomonori Kanda
    • 4
  • Yukihisa Tamaki
    • 5
  • Kazuro Sugimura
    • 1
  1. 1.Department of RadiologyKobe University School of MedicineKobeJapan
  2. 2.Department of Obstetrics and GynecologyKobe University School of MedicineKobeJapan
  3. 3.Department of Radiology DivisionKobe University HospitalKobeJapan
  4. 4.Department of RadiologyTeikyo University School of MedicineTokyoJapan
  5. 5.Department of Radiation OncologyShimane University School of MedicineShimaneJapan
  6. 6.Department of RadiologyKobe University Graduate School of MedicineKobeJapan

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