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Clinical Meaning of 18F-FDG PET/CT Incidental Gynecological Uptake: An 8-Year Retrospective Analysis

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Indian Journal of Gynecologic Oncology Aims and scope Submit manuscript

Abstract

Objective

Incidentalomas in 18F-FDG PET/CT scan are a real and known challenge in oncological physician work, and to establish the nature of incidental findings is mandatory for subsequent clinical decision.

The aim of this study is to evaluate the prevalence and the clinical significance of 18F-FDG PET/CT gynecological incidental uptake.

Materials and Methods

We have retrospectively evaluated 11,000 women who underwent 18F-FDG PET/CT from January 2008 to December 2015. The PET images were analyzed qualitatively, and the value of maximum standardized uptake value (SUVmax) was measured for the semi-quantitative analysis. Second imaging or histological examination was performed to obtain the final diagnosis.

Results

Unexpected FDG uptake in female reproductive organs was found in 125 (1.1%) 18F-FDG PET scan performed in 125 different women. 70 focal uptake was in reported in uterus, 33 in ovaries and 13 in both sites. In 64 patients, gynecological uptake was judged as physiological, in 41 as indeterminate and in 20 as malignant. After subsequent follow-up, 13 incidentalomas were classified as malignant, 19 as benign and 93 as physiological. Average SUVmax in malignant lesions was significantly higher than non-malignant (19.64 vs 6.91; p < 0.01), and ROC analysis shows a cutoff value of 8.4 with a sensitivity of 100% and specificity of 77%. No patients with uptake judged as physiological found malignancy after follow-up exams. Eleven of the 13 malignancies were found in the 25 women in menopause.

Conclusion

18F-FDG gynecological uptake can have many different meanings: a correct anamnesis, related to the PET images, could be useful in characterization of physiological uptake. SUVmax was significantly higher in malignant lesion, and incidental findings in menopause have a higher probability of malignancy.

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Authors and Affiliations

  1. Nuclear Medicine, ASST Spedali Civili Brescia, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy

    Pietro Bellini, Domenico Albano, Francesco Dondi, Angelica Mazzoletti, Raffaele Giubbini & Francesco Bertagna

  2. Nuclear Medicine, ASST Spedali Civili Brescia, Brescia, Italy

    Silvia Lucchini

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  1. Pietro Bellini
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  2. Domenico Albano
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  3. Francesco Dondi
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  4. Angelica Mazzoletti
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  5. Silvia Lucchini
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  6. Raffaele Giubbini
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  7. Francesco Bertagna
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Correspondence to Pietro Bellini.

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Bellini, P., Albano, D., Dondi, F. et al. Clinical Meaning of 18F-FDG PET/CT Incidental Gynecological Uptake: An 8-Year Retrospective Analysis. Indian J Gynecol Oncolog 19, 99 (2021). https://doi.org/10.1007/s40944-021-00596-8

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  • DOI: https://doi.org/10.1007/s40944-021-00596-8

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