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Shih IL, Yen RF, Chen CA, Cheng WF, Chen BB, Zheng QY, Cheng MF, Chen JLY, Shih TTF. PET/MRI in Endometrial Cancer: Imaging Biomarkers are Associated with Disease Progression and Overall Survival. Acad Radiol 2024; 31:939-950. [PMID: 37714718 DOI: 10.1016/j.acra.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/22/2023] [Accepted: 08/10/2023] [Indexed: 09/17/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the association between positron emission tomography (PET)/magnetic resonance imaging (MRI) biomarkers and survival outcomes in patients with endometrial cancer. MATERIALS AND METHODS Between April 2014 and April 2016, 88 patients with newly diagnosed endometrial cancer participated this prospective study and underwent [18F] fluorodeoxyglucose PET/MRI. Sixty-nine patients with measurable tumors on PET/MRI were included in the image analysis. Imaging biomarkers included the minimum and mean apparent diffusion coefficients (ADCmin and ADCmean), maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumors. The log-rank test and Cox proportional hazards model were used to assess the relationship between imaging biomarkers and survival. RESULTS After a median follow-up of 80 months, 15 (22%) patients had tumor progression and six (9%) patients died. The results of ADCmin, ADCmean, and SUVmax did not show a significant association with progression-free survival (PFS) and overall survival (OS). Significantly shorter PFS was noted in patients with primary tumors with higher MTV (P < 0.001) and TLG (P < 0.001). Significantly shorter OS was also noted in patients with primary tumors with higher MTV (P = 0.048) and TLG (P = 0.034). In the multivariate analysis, MTV was an independent predictor of PFS (hazard ratio = 10.84, P = 0.033). CONCLUSION PET/MRI biomarkers, particularly MTV and TLG, are associated with PFS and OS in patients with endometrial cancer. MTV was an independent predictor of PFS.
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Affiliation(s)
- I-Lun Shih
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan (I.-L.S., B.-B.C., Q.-Y.Z., T.T.- F.S.); Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan (I.-L.S., R.-F.Y., B.-B.C., Q.-Y.Z., M.-F.C., J.L.-Y.C., T.T.-F.S.)
| | - Ruoh-Fang Yen
- Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan (I.-L.S., R.-F.Y., B.-B.C., Q.-Y.Z., M.-F.C., J.L.-Y.C., T.T.-F.S.); Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan (R.-F.Y., M.-F.C.)
| | - Chi-An Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan (C.-A.C., W.-F.C.); Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan (C.-A.C., W.-F.C.)
| | - Wen-Fang Cheng
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan (C.-A.C., W.-F.C.); Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan (C.-A.C., W.-F.C.)
| | - Bang-Bin Chen
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan (I.-L.S., B.-B.C., Q.-Y.Z., T.T.- F.S.); Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan (I.-L.S., R.-F.Y., B.-B.C., Q.-Y.Z., M.-F.C., J.L.-Y.C., T.T.-F.S.)
| | - Quan-Yin Zheng
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan (I.-L.S., B.-B.C., Q.-Y.Z., T.T.- F.S.); Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan (I.-L.S., R.-F.Y., B.-B.C., Q.-Y.Z., M.-F.C., J.L.-Y.C., T.T.-F.S.)
| | - Mei-Fang Cheng
- Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan (I.-L.S., R.-F.Y., B.-B.C., Q.-Y.Z., M.-F.C., J.L.-Y.C., T.T.-F.S.); Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan (R.-F.Y., M.-F.C.)
| | - Jenny Ling-Yu Chen
- Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan (I.-L.S., R.-F.Y., B.-B.C., Q.-Y.Z., M.-F.C., J.L.-Y.C., T.T.-F.S.); Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (J.L.-Y.C.)
| | - Tiffany Ting-Fang Shih
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan (I.-L.S., B.-B.C., Q.-Y.Z., T.T.- F.S.); Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan (I.-L.S., R.-F.Y., B.-B.C., Q.-Y.Z., M.-F.C., J.L.-Y.C., T.T.-F.S.).
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Noriega-Álvarez E, García Vicente AM, Jiménez Londoño GA, Martínez Bravo WR, González García B, Soriano Castrejón ÁM. A systematic review about the role of preoperative 18F-FDG PET/CT for prognosis and risk stratification in patients with endometrial cancer. Rev Esp Med Nucl Imagen Mol 2023; 42:24-32. [PMID: 34172434 DOI: 10.1016/j.remnie.2021.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To analyse the available literature on the prognostic value of preoperative 18F-FDG PET/CT metabolic parameters and their usefulness in risk stratification in patients with endometrial cancer (EC). MATERIAL AND METHODS Pubmed searches used "(endometr* OR uter*) AND (PET OR FDG)" as keywords from January-2000 to June-2020. References in included articles were checked for possible publications not included in the first search. Studies evaluating the prognostic value of preoperative 18F-FDG PET/CT and its role for risk stratification in patients with EC were included. Non-original articles (reviews, editorials, letters, legal cases, interviews, case reports, etc.) were not included. RESULTS Twenty-six studies (1918 patients) were selected according to the inclusion criteria in this review. Thirteen studies (939 patients) related to the prognostic role of preoperative 18F-FDG PET/CT and 14 studies (1036 patients) related to its role in risk stratification were included. Parameters such as SUVmax, metabolic tumour volume (MTV) and total lesion glycolysis (TLG) of the primary tumour were analysed. CONCLUSIONS Preoperative SUVmax is useful for non-invasive diagnosis and for deciding the appropriate therapeutic strategy, as it could be used as an independent prognostic marker for recurrence and survival in EC. In addition, both preoperative VTM and GTL could be independent prognostic factors for predicting recurrence and survival, but there is still insufficient scientific evidence. The usefulness of SUVmax for risk stratification is limited (there is insufficient literature that 18F-FDG PET/CT can replace surgical staging), although VTM and GTL are more accurate and have a valuable role in risk stratification of EC. However, larger multicentre studies with adequate follow-up time are needed to confirm these findings.
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Affiliation(s)
- Edel Noriega-Álvarez
- Nuclear Medicine Department, University Hospital of Ciudad Real; SEMNIM Musculoeskeletal Pathology Task Group/EANM Inflammation & Infection Committee.
| | - Ana M García Vicente
- Nuclear Medicine Department, University Hospital of Ciudad Real; SEMNIM Oncology Task Group
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Noriega-Álvarez E, García Vicente A, Jiménez Londoño G, Martínez Bravo W, González García B, Soriano Castrejón Á. Revisión sistemática sobre el papel de la 18F-FDG PET/TC preoperatoria para el pronóstico y la estratificación de riesgo en pacientes con cáncer de endometrio. Rev Esp Med Nucl Imagen Mol 2022. [DOI: 10.1016/j.remn.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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4
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Relationship between 18F-fluorodeoxyglucose PET/computed tomography metabolic parameters and clinicopathology in endometrial cancer. Nucl Med Commun 2022; 43:1233-1238. [DOI: 10.1097/mnm.0000000000001622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Chang C, Ruan M, Lei B, Yu H, Zhao W, Ge Y, Duan S, Teng W, Wu Q, Qian X, Wang L, Yan H, Liu C, Liu L, Feng J, Xie W. Development of a PET/CT molecular radiomics-clinical model to predict thoracic lymph node metastasis of invasive lung adenocarcinoma ≤ 3 cm in diameter. EJNMMI Res 2022; 12:23. [PMID: 35445899 PMCID: PMC9023644 DOI: 10.1186/s13550-022-00895-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 04/05/2022] [Indexed: 12/25/2022] Open
Abstract
Background To investigate the value of 18F-FDG PET/CT molecular radiomics combined with a clinical model in predicting thoracic lymph node metastasis (LNM) in invasive lung adenocarcinoma (≤ 3 cm). Methods A total of 528 lung adenocarcinoma patients were enrolled in this retrospective study. Five models were developed for the prediction of thoracic LNM, including PET radiomics, CT radiomics, PET/CT radiomics, clinical and integrated PET/CT radiomics-clinical models. Ten PET/CT radiomics features and two clinical characteristics were selected for the construction of the integrated PET/CT radiomics-clinical model. The predictive performance of all models was examined by receiver operating characteristic (ROC) curve analysis, and clinical utility was validated by nomogram analysis and decision curve analysis (DCA). Results According to ROC curve analysis, the integrated PET/CT molecular radiomics-clinical model outperformed the clinical model and the three other radiomics models, and the area under the curve (AUC) values of the integrated model were 0.95 (95% CI: 0.93–0.97) in the training group and 0.94 (95% CI: 0.89–0.97) in the test group. The nomogram analysis and DCA confirmed the clinical application value of this integrated model in predicting thoracic LNM. Conclusions The integrated PET/CT molecular radiomics-clinical model proposed in this study can ensure a higher level of accuracy in predicting the thoracic LNM of clinical invasive lung adenocarcinoma (≤ 3 cm) compared with the radiomics model or clinical model alone. Supplementary Information The online version contains supplementary material available at 10.1186/s13550-022-00895-x.
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Affiliation(s)
- Cheng Chang
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China.,Clinical and Translational Center in Shanghai Chest Hospital, Shanghai Key Laboratory for Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Maomei Ruan
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China.,Clinical and Translational Center in Shanghai Chest Hospital, Shanghai Key Laboratory for Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Bei Lei
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China.,Clinical and Translational Center in Shanghai Chest Hospital, Shanghai Key Laboratory for Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Hong Yu
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wenlu Zhao
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yaqiong Ge
- GE Healthcare China, Pudong New Town, Shanghai, China
| | - Shaofeng Duan
- GE Healthcare China, Pudong New Town, Shanghai, China
| | - Wenjing Teng
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qianfu Wu
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaohua Qian
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Lihua Wang
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China
| | - Hui Yan
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China
| | - Ciyi Liu
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China
| | - Liu Liu
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China.,Clinical and Translational Center in Shanghai Chest Hospital, Shanghai Key Laboratory for Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Jian Feng
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wenhui Xie
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China. .,Clinical and Translational Center in Shanghai Chest Hospital, Shanghai Key Laboratory for Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, China.
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Tumoral volume measured preoperatively by magnetic resonance imaging is related to survival in endometrial cancer. Radiol Oncol 2021; 55:35-41. [PMID: 33885237 PMCID: PMC7877259 DOI: 10.2478/raon-2020-0064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 10/05/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The aim of the study was to determine if the endometrial tumor volume (TV) measured by magnetic resonance imaging (MRI-TV) is associated with survival in endometrial cancer and lymph nodes metastases (LN+). PATIENTS AND METHODS We evaluated the MRI imaging and records of 341 women with endometrial cancer and preoperative MRI from 2008 to 2018. The MRI-TV was calculated using the ellipsoid formula measuring three perpendicular tumor diameters. Tumor myometrial invasion was also analyzed. RESULTS Higher MRI-TV was associated with age ≥ 65y, non-endometrioid tumors, grade-3, deep-myometrial invasion, LN+ and advanced FIGO stage. There were 37 patients with LN+ (8.8%). Non-endometrioid tumors, deep-myometrial invasion, grade-3 and MRI-TV ≥ 10 cm3 were the factors associated with LN+. Using a receiver operating characteristic [ROC] curve, the MRI-TV cut-off for survival was 10 cm3 (area under curve [AUC] = 0.70; 95% CI: 0.61-0.73). 5 years disease-free (DFS) and overall survival (OS) was significantly lower in MRI-TV ≥ 10 cm3 (69.3% vs. 84.5%, and 75.4% vs. 96.1%, respectively). MRI-TV was considered an independent factor of DFS (HR: 2.20, 95% CI: 1.09-4.45, p = 0.029) and OS (HR: 3.88, 95% CI: 1.34-11.24, p = 0.012) in multivariate analysis. CONCLUSIONS MRI-TV was associated with LN+, and MRI-TV ≥ 10 cm3 was an independent prognostic factor of lower DFS and OS. The MRI-TV can be auxiliary information to plan the surgery strategy and predict the adjuvant treatment in women with endometrial cancer.
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Prognostic value of metabolic tumor volume and total lesion glycolysis assessed by 18F-FDG PET/CT in endometrial cancer. Nucl Med Commun 2020; 40:1099-1104. [PMID: 31568194 DOI: 10.1097/mnm.0000000000001091] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Surgical staging is the most confidential method for prognosis prediction. However, in which stage the surgery is needed and the treatment management of these patients is controversial. Presentation of new determinant factors with imaging methods for prediction of poor prognosis can provide better disease management. The aim of our study was to demonstrate the ability of metabolic tumor volume and total lesion glycolysis as a prognostic factor to predict the disease-free survival time, necessity of adjuvant radiotherapy-chemotherapy, and the association of these parameters with the clinicopathological features. METHODS Forty-four endometrial cancer diagnosed patients whose PET/CT scans were performed for treatment planning were included in our study. Metabolic parameters (SUVmax, metabolic tumor volume, total lesion glycolysis) of the primary tumor were calculated. Abdominal hysterectomy was performed for all patients. Histopathologic findings were noted. Patients were followed for 31.4 ± 14.8 months. RESULTS Metabolic tumor volume and total lesion glycolysis were significant prognostic factors for disease-free survival, whereas SUVmax did not effect disease-free survival. According to regression analysis, only metabolic tumor volume was found significant for radiotherapy planning (cutoff metabolic tumor volume; 26.30 ml). There was significant association between metabolic tumor volume, total lesion glycolysis and early-stage, myometrial invasion, and lymph node positivity. We observed only weak association between SUVmax and myometrial invasion. ROC curve calculated metabolic tumor volume and total lesion glycolysis cutoff values as 19.6 ml and 90 g for early-stage, 14.3 ml and 173.4 g for myometrial invasion, and 29.7 ml and 283.1 g for lymph node positivity, respectively. CONCLUSION Metabolic tumor volume and total lesion glycolysis may be used as prognostic factors for endometrial cancer. The association between SUVmax and clinical findings, disease-free survival, histopathological features are weak. Further studies are needed for demonstrating the prognostic value of metabolic volumetric parameters.
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Stewart KI, Chasen B, Erwin W, Fleming N, Westin SN, Dioun S, Frumovitz M, Ramirez PT, Lu KH, Wong F, Aloia TA, Soliman PT. Preoperative PET/CT does not accurately detect extrauterine disease in patients with newly diagnosed high-risk endometrial cancer: A prospective study. Cancer 2019; 125:3347-3353. [PMID: 31225906 DOI: 10.1002/cncr.32329] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND The identification of extrauterine disease is critical to the management of patients with high-risk endometrial cancer. The purpose of the current study was to determine the accuracy of preoperative positron emission tomography (PET)/computed tomography (CT) in the detection of extrauterine disease. METHODS Women with high-risk endometrial cancer were enrolled prospectively and underwent preoperative PET/CT followed by surgery, including sentinel lymph node biopsy and lymphadenectomy. Primary tumor factors on PET/CT were correlated with lymph node pathology. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the detection of lymphadenopathy and peritoneal disease by PET/CT. RESULTS A total of 112 patients were enrolled and underwent PET/CT between April 2013 and May 2016, 108 of whom were evaluable. On PET/CT, 21 patients (19.4%) were found to have extrauterine disease, 18 (17%) had positive lymph nodes, and 8 (7%) had peritoneal disease. A total of 108 patients underwent surgery, 103 of whom (95%) underwent lymphadenectomy. The sensitivity of PET/CT to detect positive lymph nodes was 45.8%, with a specificity of 91.1%, positive predictive value of 61.1%, and negative predictive value of 84.7%. The false-negative rate was 54.2%. There was no difference in primary tumor characteristics on imaging noted between patients with positive and negative lymph nodes. The sensitivity of PET/CT to detect peritoneal disease was 37.5%, with a specificity of 97.8%, positive predictive value of 75%, and negative predictive value of 90.0%. The false-negative rate was 62.5%. CONCLUSIONS Preoperative PET/CT did not reliably predict the presence of extrauterine disease in women with high-risk endometrial cancer. Given the high false-negative rates, PET/CT should not be used in the preoperative treatment planning of these patients.
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Affiliation(s)
- Katherine I Stewart
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Beth Chasen
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William Erwin
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nicole Fleming
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shannon N Westin
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shayan Dioun
- Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, New York
| | - Michael Frumovitz
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Franklin Wong
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas A Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pamela T Soliman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Clinical and prognostic value of 18F-FDG PET/CT in recurrent endometrial carcinoma. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Prognostic role of FDG PET-derived parameters in preoperative staging of endometrial cancer. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2018.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mapelli P, Bergamini A, Fallanca F, Rancoita PMV, Cioffi R, Incerti E, Rabaiotti E, Petrone M, Mangili G, Candiani M, Gianolli L, Picchio M. Prognostic role of FDG PET-derived parameters in preoperative staging of endometrial cancer. Rev Esp Med Nucl Imagen Mol 2018; 38:3-9. [PMID: 30573387 DOI: 10.1016/j.remn.2018.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/12/2018] [Accepted: 06/26/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate the preoperative prognostic role of 18F-FDG PET/CT in patients with endometrial carcinoma (EC). METHODS 18F-FDG PET/CT was performed in 57 patients for EC preoperative staging. Maximum and mean standardized uptake values (SUVmax, mean), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of primary tumors, at different thresholds of 40%, 50%, 60% (40-50-60), were evaluated and compared with anatomopathological features. The diagnostic performance of PET-parameters (categorized by ROC analysis) in discriminating low-intermediate and high-risk disease and the prognostic role on survival (overall survival -OS; disease free survival - DFS) was evaluated. RESULTS The categorized TLG40-50-60 were the only parameters related to FIGO stage I versus II-III-IV (p = 0.0035 for all). The cut-off values for risk stratification were 83.69, 61.81 and 41.32, respectively (sensitivity: 60.00%; specificity; 71.43% for all parameters). Pathological stage 1 (pT1) of the primary tumor was predicted by MTV60 and TLG40-50 (p = 0.0328, 0.0240, 0.0147, respectively). The optimal thresholds were 7.795, 99.55 and 77.58, respectively (sensitivity: 38.46%, 53.85% and 53.85%, respectively; specificity: 88.64%, 79.55% and 81.82%, respectively). SUVmax and SUVmean40-50-60 were the only parameters discriminating endometrioid from non-endometrioid subtype. The corresponding sensitivity was 64.86% and 62.16% for SUVmax and SUVmean 50-60 and 62.16% for SUVmean40; specificity was 70.00% for all parameters. The mean (SD) OS was 79.77% (3.34%) and the mean DFS was 77.89% (3.73%). The tumor type was the only variable significantly associated with OS (p = 0.0486). TLG50 > 77.58 cm3 was the only variable associated with a higher risk of relapse (p = 0.0472). CONCLUSION TLG40-50-60 and MTV60 of primary EC have prognostic value in discriminating FIGO and pathological staging. These results suggest a possible role of these parameters in predicting EC aggressiveness, thus improving the preoperative characterization of endometrial cancer.
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Affiliation(s)
- P Mapelli
- Vita-Salute San Raffaele University, Milan, Italy; Unit of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - A Bergamini
- Unit of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - F Fallanca
- Unit of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - P M V Rancoita
- University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - R Cioffi
- Unit of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - E Incerti
- Unit of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - E Rabaiotti
- Unit of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Petrone
- Unit of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - G Mangili
- Unit of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Candiani
- Unit of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - L Gianolli
- Unit of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Picchio
- Vita-Salute San Raffaele University, Milan, Italy; Unit of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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12
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Albano D, Zizioli V, Odicino F, Giubbini R, Bertagna F. Clinical and prognostic value of 18F-FDG PET/CT in recurrent endometrial carcinoma. Rev Esp Med Nucl Imagen Mol 2018; 38:87-93. [PMID: 30573388 DOI: 10.1016/j.remn.2018.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/17/2018] [Accepted: 09/19/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Endometrial carcinoma (EC) is a cancer with a good overall prognosis, except in cases of recurrent or advanced EC. The aim of this study was to assess the diagnostic performance, the prognostic value and the impact on therapeutic management of 18F-FDG PET/CT in suspected recurrent EC. MATERIALS AND METHODS We retrospectively evaluated 157 patients with histologically proven EC and restaging 18F-FDG PET/CT for suspected recurrence. The PET images were analyzed visually and semi-quantitatively by measuring SUVmax, MTV and TLG. A combination of clinical/imaging follow-up and/or histopathology was taken as reference standard. Progression-free survival (PFS) and overall survival (OS) were computed using Kaplan-Meier curves. RESULTS Seventy-nine patients had positive 18F-FDG PET/CT showing the presence of at least one hypermetabolic lesion consistent with recurrence, while the remaining 78 were negative. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 18F-FDG PET/CT were 96%, 99%, 99%, 96%, 97%, respectively, and were higher compared to conventional imaging: 97%, 62%, 72%, 96%, 80%. After a mean follow-up of 39months, relapse/progression occurred in 58 patients and death in 37 with an average time of 22.1 and 27.6months, respectively. A positive 18F-FDG PET/CT and advanced FIGO stage were significantly associated with shorter PFS and OS. PET/CT results had a significant impact on therapeutic approach in 33 patients: avoiding unnecessary therapies in 28 and modifying therapy in 5. CONCLUSIONS 18F-FDG PET/CT has a very good diagnostic performance in patients with suspected recurrent EC and has an important prognostic value in assessing PFS and OS. Moreover, PET/CT allowed for a change in treatment decision in about 20% of cases.
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Affiliation(s)
- D Albano
- Medicina Nuclear, Universidad de Brescia y Hospital Civil de Brescia, Brescia, Italia.
| | - V Zizioli
- Departamento de Obstetricia y Ginecología, Hospital Civil de Brescia, Brescia, Italia
| | - F Odicino
- Departamento de Obstetricia y Ginecología, Hospital Civil de Brescia, Brescia, Italia
| | - R Giubbini
- Medicina Nuclear, Universidad de Brescia y Hospital Civil de Brescia, Brescia, Italia
| | - F Bertagna
- Medicina Nuclear, Universidad de Brescia y Hospital Civil de Brescia, Brescia, Italia
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14
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Abstract
Combined PET/computed tomography is used for oncological indications. PET/computed tomography benefits from the metabolic information of PET and the anatomic localization of computed tomography. The integrated scanner provides data with accurate registration of anatomy and molecular information. Many physiologic conditions, normal variants, and benign lesions within the pelvis and the body can cause confusion and uncertainty. False-negative results owing to low 18F-fluorodeoxyglucose uptake from the tumor can produce diagnostic challenges and inaccurate conclusions. This article reviews normal variants and potential pitfalls encountered in PET assessment of gynecologic malignancies to provide useful information for the referring and reporting physicians.
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Lee HJ, Lee JJ, Park JY, Kim JH, Kim YM, Kim YT, Nam JH. Prognostic value of metabolic parameters determined by preoperative ¹⁸F-FDG PET/CT in patients with uterine carcinosarcoma. J Gynecol Oncol 2018; 28:e43. [PMID: 28541634 PMCID: PMC5447145 DOI: 10.3802/jgo.2017.28.e43] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 02/20/2017] [Accepted: 03/06/2017] [Indexed: 12/17/2022] Open
Abstract
Objective To evaluate the prognostic value of metabolic parameters measured by preoperative 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) in patients with uterine carcinosarcoma (UCS). Methods Data of 55 eligible patients with UCS who underwent preoperative 18F-FDG PET/CT and surgical staging were analyzed retrospectively. Maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV2.5), and total lesion glycolysis (TLG2.5) of the primary tumors were measured using a SUV threshold of 2.5. The optimal cutoff value of each parameter was determined by time-dependent receiver operating characteristic curve, and its impact on progression-free survival and overall survival was evaluated by Cox proportional hazards model. Results During a median follow-up period of 29 (range, 1.5–109.4) months, 47.3% (26/55) of the patients experienced disease progression, and the disease-associated mortality rate was 43.6% (24/55). Univariate analysis determined that hazard ratios (HRs) for disease progression for SUVmax (≥8.33), MTV2.5 (≥63.92 mL), and TLG2.5 (≥396.16) were 1.930 (95% confidence interval [CI]=0.793–4.701), 3.264 (95% CI=1.466–7.268), and 2.692 (95% CI=1.224–5.924), respectively. And, HRs for death were 1.979 (95% CI=0.774–5.060), 2.764 (95% CI=1.217–6.274), and 2.721 (95% CI=1.198–6.182), respectively. While peritoneal cytology, histology, and tumor diameter were independent prognostic factors in multivariate analysis, MTV and TLG were not. Conclusion Though MTV and TLG of primary UCS were not independent predictors compared to surgically obtained data, MTV and TLG of primary UCS may provide useful information on prognosis especially in patients who are not able to undergo surgical staging.
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Affiliation(s)
- Hyun Ju Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Jin Lee
- Department of Nuclear Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Jong Hyeok Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yong Man Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young Tak Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joo Hyun Nam
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Khan SR, Arshad M, Wallitt K, Stewart V, Bharwani N, Barwick TD. What’s New in Imaging for Gynecologic Cancer? Curr Oncol Rep 2017; 19:85. [DOI: 10.1007/s11912-017-0640-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Prognostic Evaluation of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Endometrial Cancer. Int J Gynecol Cancer 2017; 27:1675-1684. [DOI: 10.1097/igc.0000000000001057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lee I, Im HJ, Solaiyappan M, Cho SY. Comparison of novel multi-level Otsu (MO-PET) and conventional PET segmentation methods for measuring FDG metabolic tumor volume in patients with soft tissue sarcoma. EJNMMI Phys 2017; 4:22. [PMID: 28921170 PMCID: PMC5603470 DOI: 10.1186/s40658-017-0189-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 09/01/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND We have previously developed a novel and highly consistent PET segmentation algorithm using a multi-level Otsu method (MO-PET). The aim of this study was to evaluate the reliability of MO-PET compared to conventional PET segmentation methods for measuring 18F-FDG (FDG) PET metabolic tumor volume (MTV) in patients with soft tissue sarcoma (STS). Clinical and imaging data were obtained from the Cancer Imaging Archive. Forty-eight STS patients with FDG PET/CT and MR prior to therapy were analyzed. MTV of the tumor using MO-PET was compared to other conventional methods (absolute SUV threshold values of 2.0, 2.5, or 3.0 and percentage of tumor SUVmax values of 30, 40, 50, or 60%) and gradient-based method (PET Edge™). The reference volume was defined as an MR-based gross tumor volume (GTV). Spearman, intra-class correlation, and Bland-Altman analysis were performed to evaluate the correlation and agreement of MTV to GTV. RESULTS MTVs obtained using each conventional SUV parameter, PET Edge™, and MO-PET were highly correlated with the GTV in Spearman and intra-class correlation analysis (p < 0.05). MO-PET and PET Edge™ showed high intra-class correlation coefficient of MTV to GTV (0.93 and 0.84, respectively). The Bland-Altman bias results showed the highest agreement for MTV using MO-PET with GTV (26.0 ± 489.6 cm3) compared to other methods (SUV 2.0 with - 69.3 ± 765.8, 30% SUVmax with - 255.0 ± 876.6, and PET Edge™ with - 26.46 ± 668.82 cm3). CONCLUSIONS PET MTV segmented with MO-PET showed higher correlation and agreement with GTV in comparison to conventional percentage SUVmax and absolute SUV threshold-based PET segmentation methods. MO-PET is comparable to PET Edge™. MO-PET is a reliable and consistent method for measuring tumor MTV.
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Affiliation(s)
- Inki Lee
- Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Hyung-Jun Im
- Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Steve Y Cho
- Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
- Radiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
- University of Wisconsin Carbon Cancer Center, Madison, WI, USA.
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Zhou X, Chen R, Huang G, Liu J. Potential clinical value of PET/CT in predicting occult nodal metastasis in T1-T2N0M0 lung cancer patients staged by PET/CT. Oncotarget 2017; 8:82437-82445. [PMID: 29137276 PMCID: PMC5669902 DOI: 10.18632/oncotarget.19535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 03/16/2017] [Indexed: 11/25/2022] Open
Abstract
We assessed the clinical value of 2-fluoro-2-deoxyglucose (18F-FDG) PET/CT imaging for predicting occult nodal metastasis in non-small cell lung cancer (NSCLC) patients. This retrospective study included 54 patients with T1-2N0M0 NSCLC who had undergone 18F-FDG PET/CT before surgery. Occult nodal metastasis was detected in 25.9% (14/54) of the patients. Immunohistochemical analysis revealed that increased glucose transporter 1 expression was associated with occult nodal metastasis, but hexokinase 2 expression was not. Compared to the negative nodal metastasis group, the positive nodal metastasis group was associated with increased maximum standardized uptake value (SUVmax) and tumor size. Multivariate analysis indicated that SUVmax and tumor size were associated with nodal metastasis. Nodal metastasis could be predicted with a sensitivity of 92.9% and a specificity of 55.0% when the SUVmax cutoff was 4.35. When patients were divided into low-risk (tumor size ≤ 2.5 cm and SUVmax ≤ 4.35), moderate-risk (tumor size ≤ 2.5 cm and SUVmax > 4.35 or tumor size > 2.5 cm and SUVmax ≤ 4.35) and high-risk (tumor size > 2.5 cm and SUVmax > 4.35) groups, the lymph node metastasis rates were 4.3%, 22.7%, and 88.9%, respectively. These results indicate that the combination of SUVmax and tumor size has potential clinical value for predicting occult nodal metastasis in NSCLC patients.
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Affiliation(s)
- Xiang Zhou
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ruohua Chen
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Gang Huang
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianjun Liu
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Abstract
Gynecologic cancer is a heterogeneous group of diseases both functionally and morphologically. Today, PET coupled with computed tomography (PET/CT) or PET/MR imaging play a central role in the precision medicine algorithm of patients with gynecologic malignancy. In particular, PET/CT and PET/MR imaging are molecular imaging techniques that not only are useful tools for initial staging and restaging but provide anatomofunctional insight and can serve as predictive and prognostic biomarkers of response in patients with gynecologic malignancy.
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Yunokawa M, Yoshida H, Watanabe R, Noguchi E, Shimomura A, Shimoi T, Yonemori K, Shimizu C, Fujiwara Y, Tamura K. Allred score is a promising predictor of prognosis and medroxyprogesterone acetate efficacy in patients with endometrial cancer. Cancer Chemother Pharmacol 2017; 80:127-134. [DOI: 10.1007/s00280-017-3342-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 05/20/2017] [Indexed: 12/11/2022]
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Kang SY, Cheon GJ, Lee M, Kim HS, Kim JW, Park NH, Song YS, Chung HH. Prediction of Recurrence by Preoperative Intratumoral FDG Uptake Heterogeneity in Endometrioid Endometrial Cancer. Transl Oncol 2017; 10:178-183. [PMID: 28167243 PMCID: PMC5293736 DOI: 10.1016/j.tranon.2017.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/20/2016] [Accepted: 01/05/2017] [Indexed: 02/04/2023] Open
Abstract
PURPOSE: To investigate the prognostic value of preoperative intratumoral 18F-FDG uptake heterogeneity (IFH) derived from positron emission tomography (PET)/computed tomography (CT) in patients with endometrioid endometrial cancer. METHODS: We retrospectively evaluated clinicopathological data from patients with pathologically proven endometrioid endometrial cancer who had undergone 18F-FDG PET/CT scans before surgery. Patients were divided into two groups according to their IFH. The main outcome measure was disease-free survival (DFS). RESULTS: Between January 2010 and January 2015, data from 72 patients were available for analysis. The median duration of DFS was 23 months (range, 6 to 57 months), and 4 (5.6%) patients experienced recurrence. There were significant differences in tumor size, IFH, and DFS between patients with and without recurrence. In regression analysis, high IFH value [P = .007, hazard ratio (HR) 2.545, 95% confidence interval (CI) 1.468-8.674] was the only independent risk factor for recurrence. The Kaplan-Meier survival graphs showed that DFS significantly differed in groups categorized based on IFH (P < .001, log-rank test). CONCLUSIONS: Preoperative IFH measured by 18F-FDG PET/CT was associated with recurrence of endometrioid endometrial cancer. The finding supports evidence that FDG-based heterogeneity can be a novel and useful predictor of endometrioid endometrial cancer recurrence.
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Affiliation(s)
- Seo Young Kang
- Department of Nuclear Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Maria Lee
- Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Noh-Hyun Park
- Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong Sang Song
- Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea..
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Yahata T, Yagi S, Mabuchi Y, Tanizaki Y, Kobayashi A, Yamamoto M, Mizoguchi M, Nanjo S, Shiro M, Ota N, Minami S, Terada M, Ino K. Prognostic impact of primary tumor SUV max on preoperative 18F-fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography in endometrial cancer and uterine carcinosarcoma. Mol Clin Oncol 2016; 5:467-474. [PMID: 27703679 DOI: 10.3892/mco.2016.980] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 07/06/2016] [Indexed: 01/03/2023] Open
Abstract
The objective of the present study was to investigate the usefulness of the maximum standardized uptake value (SUVmax) of the primary tumor on preoperative 18F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography and computed tomography (PET/CT) as a prognostic indicator in patients with endometrial neoplasms. A total of 75 patients with endometrial cancer or uterine carcinosarcoma who underwent surgical treatment were included in the present study. All patients underwent preoperative PET/CT, and the correlation between the SUVmax of the primary tumor and clinical outcomes was analyzed. The SUVmax was significantly higher in patients with stage II/III disease, a histology of grade 3 endometrioid adenocarcinoma and carcinosarcoma, a positive lymph node (LN) status, positive lymph-vascular space involvement (LVSI), and deep (≥1/2) myometrial invasion. Receiver operating characteristic curve analysis revealed that the optimal cut-off values of SUVmax for predicting a positive LN, LVSI and deep myometrial invasion were 7.49, 6.45 and 6.45, respectively. The overall survival (OS) and progression-free survival (PFS) of patients with a high SUVmax were significantly lower compared with those of patients with a low SUVmax using the cut-off value of 7.30. However, no significant difference was observed in the OS or PFS between the high and low SUVmax groups when analyzed in carcinosarcoma patients alone. Finally, multivariate analyses demonstrated that the SUVmax of the primary tumor was an independent prognostic factor for impaired PFS in 55 endometrioid adenocarcinoma patients; however, not in all patients, including those with carcinosarcoma. The present findings demonstrated that the SUVmax of the primary tumor may be a useful biomarker for predicting clinical outcomes of patients with endometrial cancer, although its prognostic impact appears to be limited in patients with uterine carcinosarcoma.
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Affiliation(s)
- Tamaki Yahata
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Shigetaka Yagi
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Yasushi Mabuchi
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Yuko Tanizaki
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Aya Kobayashi
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Madoka Yamamoto
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Mika Mizoguchi
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Sakiko Nanjo
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Michihisa Shiro
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Nami Ota
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Sawako Minami
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Masaki Terada
- Wakayama Minami Radiology Clinic, Wakayama 641-0012, Japan
| | - Kazuhiko Ino
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
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Lee JW, Heo EJ, Moon SH, Lee H, Cheon GJ, Lee M, Kim HS, Chung HH. Prognostic value of total lesion glycolysis on preoperative 18F-FDG PET/CT in patients with uterine carcinosarcoma. Eur Radiol 2016; 26:4148-4154. [DOI: 10.1007/s00330-016-4264-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/25/2016] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
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Pan Y, Yao Y, Ma Y. Standardized Uptake Value on F-FDG PET/CT as a Prognostic Factor for Survival of Women with Malignant Uterine Tumors: A Meta-Analysis. Gynecol Obstet Invest 2015; 81:000433598. [PMID: 26337494 DOI: 10.1159/000433598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Malignant uterine tumors are crucial in the evaluation of prognosis and the determination of therapeutic strategy. AIM This meta-analysis of the available literature aimed to investigate the prognostic value of standardized uptake value (SUV) on fluorine-18-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) in uterine malignancies before treatment. METHODS The PubMed, MEDLINE and EMBASE databases (1990 to February 2014) were searched to identify studies evaluating SUV on 18F-FDG PET/CT as a prognostic tool for predicting long-term survival in patients with carcinomas of the uterus. The χ2 test and the I2 index were used to estimate heterogeneity among the trials selected in the meta-analysis. The combined hazard ratio was calculated by using a fixed- or random-effects model according to heterogeneity. RESULTS Thirteen studies with a total of 1,196 patients were eligible for analysis. High pretreatment SUVmax was significantly associated with poorer event-free survival and overall survival, and the summarized hazard ratio was 3.33 (95% confidence interval 2.34-4.74) and 1.31 (95% confidence interval 1.03-1.67), respectively. CONCLUSION The present evidence indicates that SUV on 18F-FDG PET/CT seems to be a valuable prognostic indicator for survival of patients with malignant uterine tumors. Given that 18F-FDG PET/CT can provide both morphologic and functional information, we suggest utilizing PET/CT and its quantitative marker in uterine malignancies before treatment. © 2015 S. Karger AG, Basel.
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Affiliation(s)
- Yifan Pan
- Department of Nuclear Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
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Husby JA, Reitan BC, Biermann M, Trovik J, Bjørge L, Magnussen IJ, Salvesen ØO, Salvesen HB, Haldorsen IS. Metabolic Tumor Volume on 18F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients. J Nucl Med 2015; 56:1191-8. [PMID: 26045311 DOI: 10.2967/jnumed.115.159913] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 05/20/2015] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED Our objective was to prospectively explore the diagnostic value of (18)F-FDG PET/CT for preoperative staging in endometrial carcinomas and to investigate whether (18)F-FDG PET-specific quantitative tumor parameters reflect clinical and histologic characteristics. METHODS Preoperative (18)F-FDG PET/CT was prospectively performed on 129 consecutive endometrial carcinoma patients. Two physicians who did not know the clinical findings or staging results independently reviewed the images, assessing primary tumor, cervical stroma involvement and metastatic spread, and determining maximum and mean standardized uptake value (SUVmax and SUVmean, respectively) for tumor, metabolic tumor volume (MTV), and total lesion glycolysis (TLG). All parameters were analyzed in relation to histomorphologic and clinical tumor characteristics. Receiver-operating-characteristic curves for identification of deep myometrial invasion and lymph node metastases were generated, and MTV cutoffs for predicting deep myometrial invasion and lymph node metastases were calculated. RESULTS The sensitivity, specificity, and accuracy of (18)F-FDG PET/CT for the detection of lymph node metastases were 77%-85%, 91%-96%, and 89%-93%, respectively. SUVmax, SUVmean, MTV, and TLG were significantly related to deep myometrial invasion, presence of lymph node metastases, and high histologic grade (P < 0.015 for all) and independently predicted deep myometrial invasion (P < 0.015) and lymph node metastases (P < 0.025) after adjustment for preoperative histologic risk (based on subtype and grade) in endometrial biopsies. Optimal cutoffs for MTV in predicting deep myometrial invasion (20 mL) and the presence of lymph node metastases (30 mL) yielded odds ratios of 7.8 (P < 0.001) and 16.5 (P = 0.001), respectively. CONCLUSION (18)F-FDG PET/CT represents a clinically valuable tool for preoperatively evaluating the presence of lymph node metastases in endometrial carcinoma patients. Applying MTV cutoffs for the prediction of deep myometrial invasion and lymph node metastases may increase diagnostic accuracy and aid preoperative identification of high-risk patients, enabling restriction of lymphadenectomy for patients with a low risk of aggressive disease.
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Affiliation(s)
- Jenny A Husby
- Center for PET/NM and Department of Radiology, Haukeland University Hospital, Bergen, Norway Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bernt C Reitan
- Center for PET/NM and Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Martin Biermann
- Center for PET/NM and Department of Radiology, Haukeland University Hospital, Bergen, Norway Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jone Trovik
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway Norway Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway; and
| | - Line Bjørge
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway Norway Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway; and
| | - Inger J Magnussen
- Center for PET/NM and Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Øyvind O Salvesen
- Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Helga B Salvesen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway Norway Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway; and
| | - Ingfrid S Haldorsen
- Center for PET/NM and Department of Radiology, Haukeland University Hospital, Bergen, Norway Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Shih IL, Yen RF, Chen CA, Chen BB, Wei SY, Chang WC, Sheu BC, Cheng WF, Tseng YH, Chen XJ, Chen CH, Wei LH, Chiang YC, Torng PL, Yen ML, Shih TTF. Standardized uptake value and apparent diffusion coefficient of endometrial cancer evaluated with integrated whole-body PET/MR: Correlation with pathological prognostic factors. J Magn Reson Imaging 2015; 42:1723-32. [PMID: 25919115 DOI: 10.1002/jmri.24932] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/14/2015] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To evaluate the correlation between maximum standardized uptake value (SUVmax ) and minimum apparent diffusion coefficient (ADCmin ) of endometrial cancer derived from an integrated positron emission tomography / magnetic resonance (PET/MR) system and to determine their correlation with pathological prognostic factors. MATERIALS AND METHODS This prospective study was approved by the Institutional Review Board of the hospital, and informed consent was obtained. Between April and December 2014, 47 consecutive patients with endometrial cancer were enrolled and underwent simultaneous PET/MR examinations before surgery. Thirty-six patients with measurable tumors on PET/MR were included for image analysis. Pearson's correlation coefficient was used to evaluate the correlation between SUVmax and ADCmin of the tumors. The Mann-Whitney U-test was utilized to evaluate relationships between these two imaging biomarkers and pathological prognostic factors. RESULTS The mean SUVmax and ADCmin were 14.7 ± 7.1 and 0.48 ± 0.13 × 10(-3) mm(2) /s, respectively. A significant inverse correlation was found between SUVmax and ADCmin (r = -0.53; P = 0.001). SUVmax was significantly higher in tumors with advanced stage, deep myometrial invasion, cervical invasion, lymphovascular space involvement, and lymph node metastasis (P < 0.05). ADCmin was lower in tumors with higher grade, advanced stage, and cervical invasion (P < 0.05). The ratio of SUVmax to ADCmin was higher in tumors with higher grade, advanced stage, deep myometrial invasion, cervical invasion, lymphovascular space involvement, and lymph node metastasis (P < 0.05). CONCLUSION SUVmax and ADCmin of endometrial cancer derived from integrated PET/MR are inversely correlated and are associated with pathological prognostic factors.
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Affiliation(s)
- I-Lun Shih
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chi-An Chen
- Department of Obstetrics & Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Bang-Bin Chen
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shwu-Yuan Wei
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Chun Chang
- Department of Obstetrics & Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Bor-Ching Sheu
- Department of Obstetrics & Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Fang Cheng
- Department of Obstetrics & Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yao-Hui Tseng
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Xin-Jia Chen
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chi-Hau Chen
- Department of Obstetrics & Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Lin-Hung Wei
- Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ying-Cheng Chiang
- Department of Obstetrics & Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pao-Ling Torng
- Department of Obstetrics & Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Men-Luh Yen
- Department of Obstetrics & Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tiffany Ting-Fang Shih
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Kitajima K, Suenaga Y, Ueno Y, Maeda T, Ebina Y, Yamada H, Okunaga T, Kubo K, Sofue K, Kanda T, Tamaki Y, Sugimura K. Preoperative risk stratification using metabolic parameters of (18)F-FDG PET/CT in patients with endometrial cancer. Eur J Nucl Med Mol Imaging 2015; 42:1268-75. [PMID: 25833351 DOI: 10.1007/s00259-015-3037-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 03/05/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the usefulness of metabolic parameters obtained by (18)F-FDG PET/CT for preoperative stratification of high-risk and low-risk endometrial carcinomas. METHODS Preoperative (18)F-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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Affiliation(s)
- Kazuhiro Kitajima
- Department of Radiology, Kobe University School of Medicine, Kobe, Japan,
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Usefulness of MRI-assisted metabolic volumetric parameters provided by simultaneous 18F-fluorocholine PET/MRI for primary prostate cancer characterization. Eur J Nucl Med Mol Imaging 2015; 42:1247-56. [DOI: 10.1007/s00259-015-3026-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 02/19/2015] [Indexed: 12/24/2022]
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Ghooshkhanei H, Treglia G, Sabouri G, Davoodi R, Sadeghi R. Risk stratification and prognosis determination using 18F-FDG PET imaging in endometrial cancer patients: A systematic review and meta-analysis. Gynecol Oncol 2014; 132:669-76. [DOI: 10.1016/j.ygyno.2014.01.039] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/17/2014] [Accepted: 01/18/2014] [Indexed: 10/25/2022]
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