Preoperative risk stratification using metabolic parameters of 18F-FDG PET/CT in patients with endometrial cancer
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To evaluate the usefulness of metabolic parameters obtained by 18F-FDG PET/CT for preoperative stratification of high-risk and low-risk endometrial carcinomas.
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.
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.
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.
KeywordsFDG PET/CT Endometrial cancer SUVmax MTV TLG
Compliance with ethical standards
Conflicts of interest
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.
This retrospective study was approved by the institutional review board, and the need for patient informed consent was waived.
We wish to express special thanks to Hirofumi R.T. Kawakami (GE healthcare) for his outstanding technical assistance.
- 11.Walentowicz-Sadlecka M, Malkowski B, Walentowicz P, Sadlecki P, Marszalek A, Pietrzak T, et al. The preoperative maximum standardized uptake value measured by 18F-FDG PET/CT as an independent prognostic factor of overall survival in endometrial cancer patients. Biomed Res Int. 2014;2014:234813.PubMedCentralPubMedCrossRefGoogle Scholar
- 18.Sudo S, Hattori N, Manabe O, Kato F, Mimura R, Magota K, et al. FDG PET/CT diagnostic criteria may need adjustment based on MRI to estimate the presurgical risk of extrapelvic infiltration in patients with uterine endometrial cancer. Eur J Nucl Med Mol Imaging. 2015;42:676–84.PubMedCrossRefGoogle Scholar
- 20.Maffione AM, Ferretti A, Grassetto G, Bellan E, Capirci C, Chondrogiannis S, et al. Fifteen different 18F-FDG PET/CT qualitative and quantitative parameters investigated as pathological response predictors of locally advanced rectal cancer treated by neoadjuvant chemoradiation therapy. Eur J Nucl Med Mol Imaging. 2013;40:853–64.PubMedCrossRefGoogle Scholar