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

European Journal of Nuclear Medicine and Molecular Imaging volume 42, pages 1268–1275 (2015)Cite this 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.

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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.

Author information

Affiliations

  1. Department of Radiology, Kobe University School of Medicine, Kobe, Japan

    Kazuhiro Kitajima, Yuko Suenaga, Yoshiko Ueno, Tetsuo Maeda, Keitarou Sofue & Kazuro Sugimura

  2. Department of Obstetrics and Gynecology, Kobe University School of Medicine, Kobe, Japan

    Yasuhiko Ebina & Hideto Yamada

  3. Department of Radiology Division, Kobe University Hospital, Kobe, Japan

    Takashi Okunaga & Kazuhiro Kubo

  4. Department of Radiology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan

    Tomonori Kanda

  5. Department of Radiation Oncology, Shimane University School of Medicine, Izumo-shi, Shimane, Japan

    Yukihisa Tamaki

  6. Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Kazuhiro Kitajima

Authors
  1. Kazuhiro Kitajima
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  2. Yuko Suenaga
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  3. Yoshiko Ueno
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  4. Tetsuo Maeda
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  5. Yasuhiko Ebina
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  7. Takashi Okunaga
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  8. Kazuhiro Kubo
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  9. Keitarou Sofue
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  10. Tomonori Kanda
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  11. Yukihisa Tamaki
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  12. Kazuro Sugimura
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Correspondence to Kazuhiro Kitajima.

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Kitajima, K., Suenaga, Y., Ueno, Y. et al. Preoperative risk stratification using metabolic parameters of 18F-FDG PET/CT in patients with endometrial cancer. Eur J Nucl Med Mol Imaging 42, 1268–1275 (2015). https://doi.org/10.1007/s00259-015-3037-2

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  • DOI: https://doi.org/10.1007/s00259-015-3037-2

Keywords

  • FDG
  • PET/CT
  • Endometrial cancer
  • SUVmax
  • MTV
  • TLG