Diagnostic imaging using positron emission tomography for gynecological malignancy

Tsuyoshi, Hideaki; Yoshida, Yoshio

doi:10.1111/jog.13436

Cited by 21 publications

(14 citation statements)

References 133 publications

(294 reference statements)

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“…It has been generally accepted that 18F-FDG-PET/CT has higher diagnostic performance than CT or MRI in detecting metastatic lymph nodes in gynecological cancer patients 26 . Although it has been reported that 18F-FDG-PET/CT reliably detects lymph node deposits with a volume larger than 80 mm 3 27 , false-positive detection of lymph node involvement has been caused by benign conditions, including systemic inflammation, infectious diseases, or immunizations 28 .…”

Section: Discussionmentioning

confidence: 99%

Pretreatment tumor-related leukocytosis misleads positron emission tomography-computed tomography during lymph node staging in gynecological malignancies

et al. 2020

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The accuracy of fluorine-18-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG-PET/CT) can be influenced by the increased glycolytic activity of inflammatory lesions. Here, using clinical data obtained from gynecological cancer patients, tumor samples and animal models, we investigate the impact of pretreatment tumor-related leukocytosis (TRL) on the diagnostic performance of 18F-FDG-PET/CT in detecting pelvic and paraaortic lymph node metastasis. We demonstrate that pretreatment TRL misleads 18F-FDG-PET/CT during lymph node staging in gynecological malignancies. In the mechanistic investigations, we show that the false-positive 18F-FDG-PET/CT result for detecting nodal metastasis can be reproduced in animal models of TRL-positive cancer bearing G-CSF expressing cervical cancer cells. We also show that increased 18F-FDG uptake in nonmetastatic nodes can be explained by the MDSC-mediated premetastatic niche formation in which proinflammatory factors, such as S100A8 or S100A9, are abundantly expressed. Together, our results suggest that the MDSC-mediated premetastatic niche created in the lymph node of TRL-positive patients misleads 18F-FDG-PET/CT for detecting nodal metastasis. 1 1234567890():,; ≥9000 6 (35.3) 11 (64.7) 7 (41.2) 10 (58.8) 5 (41.7) 7 (58.3) Statistical significance was assessed using two-sided Fisher's exact test. FDG fluorodeoxyglucose, PET positron emission tomography, CT computed tomography, WBC white blood cell.

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Section: Discussionmentioning

confidence: 99%

Pretreatment tumor-related leukocytosis misleads positron emission tomography-computed tomography during lymph node staging in gynecological malignancies

et al. 2020

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“…For the detection of lymph node metastasis, distant metastasis, peritoneal disease or recurrent disease in ovarian cancer, 18 F-FDG PET/CT could be useful compared with conventional modalities including CT or MRI (6)(7)(8)(9)(10). However, 18 F-FDG PET/CT has a limited and controversial role to play in the characterization of ovarian tumors, because the physiologically increased uptake of FDG into the normal ovaries leads to false-positive results or low diagnostic value in differentiating between borderline and benign tumors due to low FDG uptake leading to false-negative results (11).…”

Section: Introductionmentioning

confidence: 99%

“…MRI constitutes the gold standard for the characterization of suspected ovarian malignancy, and MRI with intravenous contrast administration provides the highest post-test probability of detecting ovarian cancer, compared with CT, US with color Doppler or MRI without contrast administration(3). The utility of 18 F-FDG PET/CT in the differentiation of benign and malignant ovarian tumors is reportedly limited because of false-positives resulting from physiological conditions such as in ammation or the menstrual cycle and false-negatives in diagnosing early-stage or borderline malignancies(11). In terms of 18 F-FDG PET/MRI, only fused 18 F-FDG PET/MRI…”

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confidence: 99%

Diagnostic Value of 18F-FDG PET/MRI For Staging in Patients With Ovarian Cancer

Tsuyoshi

Tsujikawa

Yamada

et al. 2020

Preprint

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Purpose To evaluate the diagnostic potential of PET/MRI with 18F-fluorodeoxyglucose (18F-FDG) in ovarian cancer. Materials and Methods Participants comprised 103 patients with suspected ovarian cancer underwent pretreatment 18F-FDG PET/MRI, contrast-enhanced CT (ceCT) and pelvic dynamic contrast-enhanced MRI (ceMRI). Diagnostic performance of 18F-FDG PET/MRI and ceMRI for assessing the characterization and the extent of the primary tumor (T stage) and 18F-FDG PET/MRI and ceCT for assessing nodal (N stage) and distant (M stage) metastases was evaluated by two experienced readers. Histopathological and follow-up imaging results were used as the gold standard. The McNemar test was employed for statistical analysis. Results Accuracy for the characterization of suspected ovarian cancer was significantly better for 18F-FDG PET/MRI (92.5%) than for ceMRI (80.6%; p < 0.05). Accuracy for T status was 96.4% and 92.9% for 18F-FDG PET/MRI and ceMRI/ceCT, respectively. Patient-based accuracies for N and M status were 100% and 100% for 18F-FDG PET/MRI and 85.2% and 30.8% for ceCT and M staging representing significant differences (p < 0.01). Lesion-based sensitivity, specificity and accuracy for N status were 78.6%, 95.7% and 93.9% for 18F-FDG PET/MRI and 42.9%, 96.6% and 90.8% for ceCT. Conclusions Use of 18F-FDG PET/MRI offers higher diagnostic value for the characterization and M staging than ceMRI and ceCT, and diagnostic value for T and N staging equivalent to ceMRI and ceCT, suggesting that 18F-FDG PET/MRI might represent a useful diagnostic alternative to conventional imaging modalities in ovarian cancer.

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Section: Introductionmentioning

confidence: 99%

Diagnostic value of 18F-FDG PET/MRI for staging in patients with ovarian cancer

Tsuyoshi

Tsujikawa

Yamada

et al. 2020

Preprint

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Purpose: To evaluate the diagnostic potential of PET/MRI with 18F-fluorodeoxyglucose (18F-FDG) in ovarian cancer.Materials and Methods: Participants comprised 103 patients with suspected ovarian cancer underwent pretreatment 18F-FDG PET/MRI, contrast-enhanced CT (ceCT) and pelvic dynamic contrast-enhanced MRI (ceMRI). Diagnostic performance of 18F-FDG PET/MRI and ceMRI for assessing the characterization and the extent of the primary tumor (T stage) and 18F-FDG PET/MRI and ceCT for assessing nodal (N stage) and distant (M stage) metastases was evaluated by two experienced readers. Histopathological and follow-up imaging results were used as the gold standard. The McNemar test was employed for statistical analysis.Results: Accuracy for the characterization of suspected ovarian cancer was significantly better for 18F-FDG PET/MRI (92.5%) [95% confidence interval (CI) 0.841–0.950] than for ceMRI (80.6%) (95%CI 0.715–0.830) (p <0.05). Accuracy for T status was 96.4% (95%CI 0.964–0.964) and 92.9% (95%CI 0.929–0.929) for 18F-FDG PET/MRI and ceMRI/ceCT, respectively. Patient-based accuracies for N and M status were 100% (95%CI 0.883–1.000) and 100% (95%CI 0.884–1.000) for 18F-FDG PET/MRI and 85.2% (95%CI 0.758–0.852) and 30.8% (95%CI 0.188–0.308) for ceCT and M staging representing significant differences (p<0.01). Lesion-based sensitivity, specificity and accuracy for N status were 78.6% (95%CI 0.571–0.913), 95.7% (95%CI 0.932–0.972) and 93.9% (95%CI 0.893–0.966) for 18F-FDG PET/MRI and 42.9% (95%CI 0.240–0.581), 96.6% (95%CI 0.943–0.984) and 90.8% (95%CI 0.868–0.941) for ceCT. Conclusions: Use of 18F-FDG PET/MRI offers better sensitivity and specificity for the characterization and M staging than ceMRI and ceCT, and diagnostic value for T and N staging equivalent to ceMRI and ceCT, suggesting that 18F-FDG PET/MRI might represent a useful diagnostic alternative to conventional imaging modalities in ovarian cancer.

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Diagnostic imaging using positron emission tomography for gynecological malignancy

Cited by 21 publications

References 133 publications

Pretreatment tumor-related leukocytosis misleads positron emission tomography-computed tomography during lymph node staging in gynecological malignancies

Pretreatment tumor-related leukocytosis misleads positron emission tomography-computed tomography during lymph node staging in gynecological malignancies

Diagnostic Value of 18F-FDG PET/MRI For Staging in Patients With Ovarian Cancer

Diagnostic value of 18F-FDG PET/MRI for staging in patients with ovarian cancer

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