18F-FDG PET in the management of endometrial cancer

Chao, Angel; Chang, Ting Chang; Ng, Koon Kwan; Hsueh, Swei; Huang, Hsuan-Rong; Chou, Hung Hsueh; Tsai, Chien Sheng; Yen, Tzu Chen; Wu, Ting-Jung; Lai, Chyong‐Huey

doi:10.1007/s00259-005-1876-y

Cited by 87 publications

(35 citation statements)

References 25 publications

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“…Several reports indicated that 18 F-FDG PET is useful for managing pre-and postoperative patients with endometrial carcinoma mainly by detecting lymph node metastasis (14)(15)(16)(17). The classification of tumor characteristics determined by 18 F-FDG uptake and the 18 F-FDG-to-18 F-FES ratio could play an important role in the differential diagnosis of endometrial lesions and in deciding the therapeutic strategy.…”

Section: Discussionmentioning

confidence: 99%

Functional Images Reflect Aggressiveness of Endometrial Carcinoma: Estrogen Receptor Expression Combined with ¹⁸F-FDG PET

Tsujikawa¹,

Yoshida

Kudo³

et al. 2009

J Nucl Med

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The grade of histologic differentiation is one of the most important prognostic factors in patients with endometrial carcinoma and postoperative staging. The aim of this study was to investigate whether 16a-18 F-fluoro-17b-estradiol ( 18 F-FES) and 18 F-FDG PET reflect clinicopathologic features in patients with endometrial tumors. Methods: A total of 22 patients with endometrial adenocarcinoma and 9 with endometrial hyperplasia (mean age, 56.0 6 15.3 y) underwent 18 F-FES PET for estrogen receptor imaging and 18 F-FDG PET. Regional values of tracer uptake were evaluated using standardized uptake value (SUV) and the SUV ratio of 18 F-FDG to 18 F-FES. The accuracy for predicting tumor aggressiveness defined as high-risk carcinoma (International Federation of Gynecology and Obstetrics [FIGO] stage $ Ic or histologic grade $ 2), low-risk carcinoma (FIGO stage # Ib and grade 1), and hyperplasia was compared for each PET parameter using receiver-operating-characteristic (ROC) analysis. The diagnostic accuracy of MRI findings for clinical staging was also compared. Results: Although the SUV for 18 F-FDG was significantly lower in endometrial hyperplasia than in carcinoma, a significant difference between high-risk and low-risk carcinoma was observed only in SUV for 18 F-FES. High-risk carcinoma showed a significantly greater 18 F-FDG-to-18 F-FES ratio (3.6 6 2.1) than did low-risk carcinoma (1.3 6 0.5, P , 0.01) and hyperplasia (0.3 6 0.1, P , 0.005). Low-risk carcinoma showed a significantly higher 18 F-FDG-to-18 F-FES ratio than hyperplasia (P , 0.0001). In ROC analysis, the most accurate diagnostic PET parameter for predicting high-risk and low-risk carcinoma was the 18 F-FDG-to-18 F-FES ratio. The optimal 18 F-FDG/ 18 F-FES cutoff value of 2.0, determined by ROC analysis, revealed 73% sensitivity, 100% specificity, and 86% accuracy, which was better than the 77% accuracy for MRI. The 18 F-FDGto-18 F-FES ratio of 0.5 yielded a correct diagnosis for carcinoma from hyperplasia with 100% accuracy. Conclusion: Endometrial carcinoma reduces estrogen dependency with accelerated glucose metabolism as it progresses to a higher stage or grade. 18 F-FES and 18 F-FDG PET studies provide a new index of the 18 F-FDG-to-18 F-FES ratio, which is considered the most informative index reflecting tumor aggressiveness. This index will be useful for making noninvasive diagnoses and deciding the appropriate therapeutic strategy for patients with endometrial carcinoma.

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Section: Discussionmentioning

confidence: 99%

Functional Images Reflect Aggressiveness of Endometrial Carcinoma: Estrogen Receptor Expression Combined with ¹⁸F-FDG PET

Tsujikawa¹,

Yoshida

Kudo³

et al. 2009

J Nucl Med

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“…As indicated by some authors, in endometrial cancer the major contribution of 18 F-FDG-PET/CT could be in the early assessment of disease recurrence after therapy [60,69]. The good performance of 18 F-FDG-PET/CT has been confirmed by Kitajima et al in a recent paper including 30 patients, that showed an overall patient-based sensitivity, specificity and accuracy of 93% [70].…”

Section: Endometrial Cancermentioning

confidence: 86%

“…Few small studies assessed the validity of PET alone in the evaluation of primary endometrial cancer, showing good levels of sensitivity (range 83.3-96.7% [59][60][61]). Torizuka et al affirmed the feasibility of PET study in the assessment of myometrial involvement, reporting a better diagnostic accuracy than MRI (86.4% versus 77.3% respectively) [59].…”

Section: Endometrial Cancermentioning

confidence: 99%

PET in uterine malignancies

Pirro¹,

Skanjeti²,

Pelosi³

2010

Health

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“…Nevertheless, misdiagnosis may occur in physiological urinary or gastrointestinal tract uptake studies or where there is active inflammation (which may give a false positive), while small or micrometastatic lesions may also be missed (false negative). In EMC, only a few available studies using a PET scan to predict LN metastasis have been reported [85][86][87][88] with a sensitivity of 67-73% and a specificity of 94-95% when used alone [85,86] or slightly improved when used in concurrence with a CT scan, with a sensitivity and specificity of 53-69 and 90-99%, respectively [87,88] .…”

Section: Myometrial Invasionmentioning

confidence: 99%

Fertility-Sparing in Endometrial Cancer

Tangjitgamol

Manusirivithaya²,

Hanprasertpong³

2009

Gynecol Obstet Invest

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Because endometrial cancer (EMC) patients frequently present at an early stage of disease, most have favorable outcomes, thus their quality of life after treatment is as important a consideration as a cure of cancer. This issue is especially important when EMC is encountered in younger or reproductive ages when the afflicted woman has not achieved her fertility function. It is a complicated situation when a physician encounters a request or question from a woman with EMC or her family concerning whether she could conceive a child prior to a definite cancer treatment. Despite being an interesting issue, there are only a few studies with definite treatment guidelines or any evidence-based recommendations concerning conservative treatment for EMC. Thus, we undertook this study to explore various considerations regarding the criteria and caveats for the management of EMC women who desire to preserve their fertility function. An algorithm guideline for conservative fertility treatment for EMC is also presented.

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18F-FDG PET in the management of endometrial cancer

Abstract: Whole-body FDG-PET coupled with MRI-CT facilitated optimal management of endometrial cancer in well-selected cases.

Cited by 87 publications

References 25 publications

Functional Images Reflect Aggressiveness of Endometrial Carcinoma: Estrogen Receptor Expression Combined with ¹⁸F-FDG PET

Functional Images Reflect Aggressiveness of Endometrial Carcinoma: Estrogen Receptor Expression Combined with ¹⁸F-FDG PET

PET in uterine malignancies

Fertility-Sparing in Endometrial Cancer

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18F-FDG PET in the management of endometrial cancer

Abstract: Whole-body FDG-PET coupled with MRI-CT facilitated optimal management of endometrial cancer in well-selected cases.

Cited by 87 publications

References 25 publications

Functional Images Reflect Aggressiveness of Endometrial Carcinoma: Estrogen Receptor Expression Combined with 18F-FDG PET

Functional Images Reflect Aggressiveness of Endometrial Carcinoma: Estrogen Receptor Expression Combined with 18F-FDG PET

PET in uterine malignancies

Fertility-Sparing in Endometrial Cancer

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Functional Images Reflect Aggressiveness of Endometrial Carcinoma: Estrogen Receptor Expression Combined with ¹⁸F-FDG PET

Functional Images Reflect Aggressiveness of Endometrial Carcinoma: Estrogen Receptor Expression Combined with ¹⁸F-FDG PET