Preoperative risk stratification using metabolic parameters of 18F-FDG PET/CT in patients with endometrial cancer

Kitajima, Kazuhiro; Suenaga, Yusaku; Ueno, Yoshiko; Maeda, Takeyasu; Ebina, Yasuhiko; Yamada, Hideto; Okunaga, Takashi; Kubo, Kazuhiro; Sofue, Keitarou; Kanda, Tomonori; Tamaki, Yukihisa; Sugimura, Kazuro

doi:10.1007/s00259-015-3037-2

Cited by 40 publications

(42 citation statements)

References 25 publications

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“…In line with this finding, adjusted for the preoperative biopsy risk assessment, MTV independently predicted deep myometrial invasion and lymph node metastases ( Table 3), suggesting that MTV may improve the preoperative identification of high-risk patients and the ability to tailor surgical and systemic therapies accordingly. Our results are in line with a recent study of 56 endometrial carcinoma patients (23) emphasizing MTV and TLG as significant predictors of several clinicopathologic characteristics and superior to SUV max in differentiating high-risk from low-risk patients. Also two studies of 76 endometrial carcinoma patients each (13,28) suggested that MTV is a promising marker for lymph node metastases and poor outcome.…”

Section: Discussionsupporting

confidence: 91%

“…As opposed to our proposed cutoff, a recent smaller study of 56 patients proposed a cutoff of 9.4 mL for MTV for differentiation between high-risk and low-risk tumors (based on surgicopathologic assessment). This differing result is possibly explained by a larger proportion of patients with an advanced FIGO stage in the cohort and differing definitions of high-and lowrisk groups (23).…”

Section: Discussionmentioning

confidence: 93%

“…18 F-FDG PET/CT combines morphologic and physiologic techniques and is the preferred imaging method for various cancers (11). Although several studies have suggested that 18 F-FDG PET/CT can be beneficial preoperatively in endometrial cancer patients (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), its clinical role in risk stratification of such patients is not well defined. Furthermore, the value of various quantitative tumor parameters and the corresponding optimal cutoffs for the prediction of tumor stage and prognosis are largely unexplored.…”

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confidence: 99%

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Metabolic Tumor Volume on ¹⁸F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients

et al. 2015

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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 (SUV max and SUV mean , 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-operatingcharacteristic 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. SUV max , SUV mean , 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 5 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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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 93%

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confidence: 99%

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Metabolic Tumor Volume on ¹⁸F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients

et al. 2015

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“…In previous studies, some authors found SUVmax correlates with histologic grade (22,23) and some did not (24,25). In our study, we found that grade 2 tumors had statistically not important but higher SUVmax values than grade 1 tumors and statistically significantly higher SUVmax values than grade 3 tumors.…”

Section: Discussionsupporting

confidence: 72%

Preoperative Positron-Emision Tomography/Computed Tomography Findings in Endometrial Cancer: A Study of 30 Cases

Altın

Kasapoglu

Tuncer

2017

Gynecol Obstet Reprod Med

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OBJECTIVE:The aim of this study was to find out if preoperative PET/CT could be a substitute for staging surgery and whether SUVmax values correlate with prognostic factors of endometrium cancer.STUDY DESIGN: 30 patients to whom18-fluorodeoxyglucose PET/CT scan was performed preoperatively were analyzed retrospectively. Standardized uptake value (SUV) was calculated on PET images. PET findings were compared with surgical and pathological findings. RESULTS:SUVmax of the endometrioid type tumors were significantly higher than non-endometrioid types (p: 0.042). SUVmax significantly differ between histologic grades (p: 0.042). SUVmax did not differ between patients who had myometrial invasion less or more than 50% and who had lymphovascular invasion or not. There was not a significant difference between SUVmax and FIGO stages also. Possibility of extra-uterine lesion in PET/CT were significantly higher in late stages (p: 0.004). Sensitivity and specificity of PET/CT for detection of beyond stage 1 disease were 50% and 67% respectively and sensitivity and specificity of PET/CT for detection of lymph node metastasis were 40% and 86% respectively. CONCLUSION:PET/CT has moderate sensitivity for pre-operative detection of beyond stage 1 cancers but it has a high specificity and low-moderate sensitivity for detection of lymph node metastasis but has high specificity. Because the positive likelihood ratios are relatively low, PET/CT cannot be a substitute for staging surgery.

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“…The cut-off value was determined by referring to data reported in previous studies. [18][19][20][21][22][23] Each VOI for calculating MTV and TLG was first placed manually, paying careful attention not to include high physiological uptake, and then MTV was automatically extracted on a workstation. The summed MTV was produced as the WB-MTV.…”

Section: Measurements Of Positron Emission Tomography/ct Parametersmentioning

confidence: 99%

Prognostic value of fluorine-18 fludeoxyglucose positron emission tomography parameters differs according to primary tumour location in small-cell lung cancer

Nobashi¹,

Koyasu²,

Nakamoto³

et al. 2016

BJR

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Objective: To investigate the prognostic value of fluorine-18 fludeoxyglucose (FDG) positron emission tomography (PET) parameters for small-cell lung cancer (SCLC), according to the primary tumour location, adjusted by conventional prognostic factors. Methods: From 2008 to 2013, we enrolled consecutive patients with histologically proven SCLC, who had undergone FDG-PET/CT prior to initial therapy. The primary tumour location was categorized into central or peripheral types. PET parameters and clinical variables were evaluated using univariate and multivariate analysis. Results: A total of 69 patients were enrolled in this study; 28 of these patients were categorized as having the central type and 41 patients as having the peripheral type. In univariate analysis, stage, serum neuron-specific enolase, whole-body metabolic tumour volume (WB-MTV) and whole-body total lesion glycolysis (WB-TLG) were found to be significant in both types of patients. In multivariate analysis, the independent prognostic factor was found to be stage in the central type, but WB-MTV and WB-TLG in the peripheral type. Kaplan-Meier analysis demonstrated that patients with peripheral type with limited disease and low WB-MTV or WB-TLG showed significantly better overall survival than all of the other groups (p , 0.0083). Conclusion: The FDG-PET volumetric parameters were demonstrated to be significant and independent prognostic factors in patients with peripheral type of SCLC, while stage was the only independent prognostic factor in patients with central type of SCLC. Advances in knowledge: FDG-PET is a non-invasive method that could potentially be used to estimate the prognosis of patients, especially those with peripheraltype SCLC.

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Preoperative risk stratification using metabolic parameters of 18F-FDG PET/CT in patients with endometrial cancer

Abstract: 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.

Cited by 40 publications

References 25 publications

Metabolic Tumor Volume on ¹⁸F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients

Metabolic Tumor Volume on ¹⁸F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients

Preoperative Positron-Emision Tomography/Computed Tomography Findings in Endometrial Cancer: A Study of 30 Cases

Prognostic value of fluorine-18 fludeoxyglucose positron emission tomography parameters differs according to primary tumour location in small-cell lung cancer

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Preoperative risk stratification using metabolic parameters of 18F-FDG PET/CT in patients with endometrial cancer

Abstract: 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.

Cited by 40 publications

References 25 publications

Metabolic Tumor Volume on 18F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients

Metabolic Tumor Volume on 18F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients

Preoperative Positron-Emision Tomography/Computed Tomography Findings in Endometrial Cancer: A Study of 30 Cases

Prognostic value of fluorine-18 fludeoxyglucose positron emission tomography parameters differs according to primary tumour location in small-cell lung cancer

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Metabolic Tumor Volume on ¹⁸F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients

Metabolic Tumor Volume on ¹⁸F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients