MRI, PET/CT and ultrasound in the preoperative staging of endometrial cancer — A multicenter prospective comparative study

Antonsen, Sofie Leisby; Jensen, Line; Loft, Annika; Berthelsen, Anne Kiil; Costa, Junia; Tabor, Ann; Qvist, I.; Hansen, Mette Rodi; Fisker, Rune Vincents; Andersen, E.; Sperling, L.; Nielsen, Anne Lerberg; Asmussen, Jon Thor; Høgdall, Estrid; Fagö-Olsen, Carsten Lindberg; Christensen, Ib Jarle; Nedergaard, Lotte; Jochumsen, Kirsten Marie; Høgdall, Claus

doi:10.1016/j.ygyno.2012.11.025

Cited by 194 publications

(192 citation statements)

References 32 publications

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“…18 F]fluoro-2-deoxy-D-glucose (FDG) PET in endometrial cancer (3,43). These studies are limited by poor sensitivity because of the rapid excretion and accumulation of FDG within the bladder, the largest study reporting 74% sensitivity in detecting lymph node involvement (3).…”

Section: Discussionmentioning

confidence: 99%

“…These studies are limited by poor sensitivity because of the rapid excretion and accumulation of FDG within the bladder, the largest study reporting 74% sensitivity in detecting lymph node involvement (3). The use of MRS in assessing endometrial cancer is limited by poor spectral signal to noise ratio (7,44).…”

Section: Discussionmentioning

confidence: 99%

“…Reliable staging, therefore, is critical to both the management and prognostic stratification of patients. Conventional imaging techniques have limited sensitivity in the assessment of lymph node status and more effective imaging modalities are urgently needed (3). Understanding the metabolic and biochemical changes that underlie the malignant progression of the disease would allow utilization of noninvasive molecular imaging techniques for clinical staging and follow-up.…”

Section: Introductionmentioning

confidence: 99%

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Alterations of Choline Phospholipid Metabolism in Endometrial Cancer Are Caused by Choline Kinase Alpha Overexpression and a Hyperactivated Deacylation Pathway

et al. 2014

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Metabolic rearrangements subsequent to malignant transformation are not well characterized in endometrial cancer. Identification of altered metabolites could facilitate imaging-guided diagnosis, treatment surveillance, and help to identify new therapeutic options. Here, we used high-resolution magic angle spinning magnetic resonance mass spectroscopy on endometrial cancer surgical specimens and normal endometrial tissue to investigate the key modulators that might explain metabolic changes, incorporating additional investigations using qRT-PCR, Western blotting, tissue microarrays (TMA), and uptake assays of [ 3 H]-labeled choline. Lipid metabolism was severely dysregulated in endometrial cancer with various amino acids, inositols, nucleobases, and glutathione also altered. Among the most important lipid-related alterations were increased phosphocholine levels (increased 70% in endometrial cancer). Mechanistic investigations revealed that changes were not due to altered choline transporter expression, but rather due to increased expression of choline kinase a (CHKA) and an activated deacylation pathway, as indicated by upregulated expression of the catabolic enzymes LYPLA1, LYPLA2, and GPCPD1. We confirmed the significance of CHKA overexpression on a TMA, including a large series of endometrial hyperplasia, atypical hyperplasia, and adenocarcinoma tissues, supporting a role for CHKA in malignant transformation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Alterations of Choline Phospholipid Metabolism in Endometrial Cancer Are Caused by Choline Kinase Alpha Overexpression and a Hyperactivated Deacylation Pathway

et al. 2014

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“…Intraoperative gross evaluation of the uterus has a sensitivity of 67%-77% with a false negative rate for detection of deep myometrial invasion of about 23%-33% [3,[12][13][14]. MRI has a sensitivity of 80% to 91% for preoperative evaluation of myometrial infiltration by endometrium carcinoma [4,[15][16][17]. Also, adding diffusion weighted imaging sequence to the standard MRI, increases the detection of deep myometrial invasion of endometrial cancer [18].…”

Section: Discussionmentioning

confidence: 99%

The prediction of myometrial infiltration by three-dimensional ultrasonography in patients with endometrial carcinoma: a validation study from Ege University Hospital.

et al. 2016

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Aim: To predict the myometrial invasion with three-dimensional (3D) ultrasonography in a cohort of patients with endometrial carcinoma by a previously described technique. Material and methods: The moyometrial infiltration was evaluated by 3D ultrasonography before surgery in 54 patients with endometrial carcinoma. After scanning the whole uterus by ultrasonography, three perpendicular planes were identified to find the shortest myometrial tumor-free distance to serosa (TDS) by examining the lateral, anterior, posterior, and fundal parts of the myometrium. Myometrial infiltration was also estimated by the subjective impression of the examiner. The reference standards consist of myometrial infiltration and TDS which are measured by an experienced pathologist. Results: Forty-five patients (age range 45-86 years) were included for the final analysis. Myometrial invasion was ˂50% in 36 and ≥50% in 9 cases at histologic sections. The TDS which is measured with 3D ultrasonography was positively correlated with histologically measured TDS (r=0.474, p=0.001). The best cut-off value for ultrasonographically measured TDS was 9 mm with a sensitivity of 89%, specifity of 61%, positive predictive value of 36%, and negative predictive value of 96%. Subjective impression has a sensitivity of 100%, specifity of 88%, positive predictive value of 69%, and negative predictive value of 100%. Cervical involvement was correctly identified in all 6 cases by subjective impression. Conclusion: This validation study confirms the 3D ultrasonography as a valuable tool for the evaluation of myometrial infiltration in patients with endometrial carcinoma.

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“…In a study of 318 patients with endometrial cancer, in predicting myometrial invasion, and was superior to those modalities for identifying cervical invasion. 42 Moreover, fusion of PET and MRI had significantly better accuracy for T staging than 18 F-FDG PET/CT, suggesting that PET/MRI has a possible role to play in the assessment of local invasion. 43 Figure 2 shows representative images.…”

Section: Uterine Endometrial Cancermentioning

confidence: 97%

Diagnostic imaging using positron emission tomography for gynecological malignancy

Tsuyoshi

Yoshida

2017

J of Obstet and Gynaecol

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Imaging has played a pivotal role in the management of gynecological malignancy. Positron emission tomography (PET), particularly 18 F-fluorodeoxyglucose ( 18 F-FDG) PET to reflect cellular glycolytic metabolism, is being increasingly used and has proven superior to conventional imaging including ultrasonography, computed tomography (CT), and magnetic resonance imaging. Studies of and evidence for the utility of 18 F-FDG PET/CT for the detection of local or metastatic disease, treatment planning, response assessment, restaging of recurrent disease, and prognostic assessment are growing. We review the latest evidence for and limitations of 18 F-FDG PET/CT in the diagnosis of gynecological malignancy. Moreover, we also describe the benefits of and evidence for other tracers.

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MRI, PET/CT and ultrasound in the preoperative staging of endometrial cancer — A multicenter prospective comparative study

Abstract: None of the modalities can yet replace surgical staging. However, they all contributed to important knowledge and were, furthermore, able to upstage low-risk patients who would not have been recommended lymph node resection based on histology and grade alone.

Cited by 194 publications

References 32 publications

Alterations of Choline Phospholipid Metabolism in Endometrial Cancer Are Caused by Choline Kinase Alpha Overexpression and a Hyperactivated Deacylation Pathway

Alterations of Choline Phospholipid Metabolism in Endometrial Cancer Are Caused by Choline Kinase Alpha Overexpression and a Hyperactivated Deacylation Pathway

The prediction of myometrial infiltration by three-dimensional ultrasonography in patients with endometrial carcinoma: a validation study from Ege University Hospital.

Diagnostic imaging using positron emission tomography for gynecological malignancy

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