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.
Similar content being viewed by others
References
Lumbreras B, Donat L, Hernandez-Aguado I. Incidental findings in imaging diagnostic tests: a systematic review. Br J Radiol. 2010;83:276–89.
Tamburello A, Treglia G, Albano D, Beragna F, Giovanella L. Prevalence and clinical significance of focal incidental 18F-FDG uptake in different organs: an evidence-based summary. Clin Transl Imaging. 2017;5:525–32.
Signore G, Albano D, Giovanella L, et al. Evidence-based data about prevalence and risk of malignancy of thyroid incidentalomas detected by different PET radiopharmaceuticals. Curr Radiopharm. 2019. https://doi.org/10.2174/1874471012666191212115732.
Bertagna F, Albano D, Giovanella L, Bonacina M, Durmo R, Giubbini R, Treglia G. 68Ga-PSMA PET thyroid incidentalomas. Hormones (Athens). 2019. https://doi.org/10.1007/s42000-019-00106-8.
Bertagna F, Albano D, Giovanella L, Giubbini R, Treglia G. F18-choline/C11-choline PET/CT thyroid incidentalomas. Endocrine. 2019;64(2):203–8. https://doi.org/10.1007/s12020-019-01841-z.
Albano D, Durmo R, Bertagna F, Giubbini R. 18F-choline PET/CT incidental thyroid uptake in patients studied for prostate cancer. Endocrine. 2019;63:531–6. https://doi.org/10.1007/s12020-018-01832-6.
Treglia G, Taralli S, Salsano M, Muoio B, Sadeghi R, Giovanella L. Prevalence and malignancy risk of focal colorectal incidental uptake detected by (18)F-FDG-PET or PET/CT: a metaanalysis. Radiol Oncol. 2014;48:99–104.
Treglia G, Bertagna F, Sadeghi R, Muoio B, Giovanella L. Prevalence and risk of malignancy of focal incidental uptake detected by fluorine-18-fluorodeoxyglucose positron emission tomography in the parotid gland: a meta-analysis. Eur Arch Otorhinolaryngol. 2015;272:3617–26.
Bertagna F, Treglia G, Orlando E, Dognini L, Giovanella L, Sadeghi R, Giubbini R. Prevalence and clinical significance of incidental F18-FDG breast uptake: a systematic review and meta-analysis. Jpn J Radiol. 2014;32:59–68.
Bertagna F, Sadeghi R, Giovanella L, Treglia G. Incidental uptake of 18F-fluorodeoxyglucose in the prostate gland. Systematic review and meta-analysis on prevalence and risk of malignancy. Nuklearmedizin. 2014;53:249–58.
Signore G, Meyer M, Albano D, Bertagna F, Nicod-Lalonde M, Schaefer N, Giovanella L, Prior JO, Treglia G. Prevalence and clinical significance of incidental 18F-FDG uptake in the pituitary. Clin Transl Imaging. 2020. https://doi.org/10.1007/s40336-020-00375-z.
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(2):266–71.
Nishizawa S, Inubushi M, Okada H. Physiological 18F-FDG uptake in the ovaries and uterus of healthy female volunteers. Eur J Nucl Med Mol Imaging. 2005;32(5):549–56. https://doi.org/10.1007/s00259-004-1703-x.
Lin SC, Yen RF, Chen YK. Dermoid cyst with secretion of CA 19–9 detected by 18F-FDG PET/CT: a case report. Medicine (Baltimore). 2020;99(10): e18988. https://doi.org/10.1097/MD.0000000000018988.
Kitajima K, Murakami K, Kaji Y, Sugimura K. Spectrum of FDG PET/CT findings of uterine tumors. AJR Am J Roentgenol. 2010;195(3):737–43. https://doi.org/10.2214/AJR.09.4074.
Liu Y. Benign ovarian and endometrial uptake on FDG PET-CT: patterns and pitfalls. Ann Nucl Med. 2009;23(2):107–12. https://doi.org/10.1007/s12149-008-0227-z.
Kilcoyne A, Chow DZ, Lee SI. FDG-PET for assessment of endometrial and vulvar cancer. Semin Nucl Med. 2019;49(6):471–83. https://doi.org/10.1053/j.semnuclmed.2019.06.011.
Khiewvan B, Torigian DA, Emamzadehfard S, Paydary K, Salavati A, Houshmand S, Werner TJ, Alavi A. An update on the role of PET/CT and PET/MRI in ovarian cancer. Eur J Nucl Med Mol Imaging. 2017;44(6):1079–91. https://doi.org/10.1007/s00259-017-3638-z.
Tsuyoshi H, Tsujikawa T, Yamada S, Okazawa H, Yoshida Y. Diagnostic value of [18F]FDG PET/MRI for staging in patients with ovarian cancer. EJNMMI Res. 2020;10(1):117. https://doi.org/10.1186/s13550-020-00712-3.
Bonacina M, Albano D, Gazzilli M, Durmo R, Cerudelli E, Bosio G, Bertagna F, Giubbini R. 18F-FDG PET/CT brown fat detection: differences between adult and pediatric population in a 12 year experience. Rev Esp Med Nucl Imagen Mol. 2019;38(4):224–8. https://doi.org/10.1016/j.remn.2019.01.006.
Amin RW, Ross AM, Lee J, Guy J, Stafford B. Patterns of ovarian cancer and uterine cancer mortality and incidence in the contiguous USA. Sci Total Environ. 2019;20(697): 134128. https://doi.org/10.1016/j.scitotenv.2019.134128.
Takagi H, Sakamoto J, Osaka Y, Shibata T, Fujita S, Sasagawa T. Utility of 18F-fluorodeoxyglucose-positron emission tomography in the differential diagnosis of benign and malignant gynaecological tumours. J Med Imaging Radiat Oncol. 2018. https://doi.org/10.1111/1754-9485.12707.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s40944-021-00596-8