Hybrid PET/MRI in Staging Endometrial Cancer

Abstract

Purpose. Assessment of deep myometrial invasion (MI) and lymphovascular space invasion (LVSI) is of utmost importance in preoperative staging of endometrial cancer (EC). Imaging parameters derived respectively from MRI and PET have shown good predictive value. Aim of the present study is to assess the diagnostic performance of hybrid 18F-FDG PET/MRI in EC staging, with particular focus on MI and LVSI detection.Methods. Prospective monocentric study including 35 patients with biopsy-proven EC undergoing preoperative 18F-FDG PET/MRI for staging purpose. Histological examination was the reference standard. PET (SUVmax, SUVmean40, MTV40, TLG40) and MRI (volume index-VI, total tumor volume-TTV, tumor volume ratio-TVR, ADCmean, ADCmin) parameters were calculated on the primary tumor, and their role in predicting histological ndings (grade, high-vs. low-risk groups, LVSI, MI, p53 hyperexpression) was assessed through a ROC analysis.Results. 18F-FDG-PET/MRI identi ed the primary tumor in all patients. In the LVSI detection, PET/MRI demonstrated high accuracy, speci city and negative predictive value (sensitivity=0.8571, speci city=0.9286, accuracy=0.9143, NPV=0.9630, PPV=0.7500). Assessment of MI using PET/MRI correctly staged 27 patients, showing a good positive predictive value (77.1%; sensitivity= 0.7273, speci city=0.8462, accuracy=0.7714, PPV=0.8889, NPV=0.647). VI, TTV, and TVR signi cantly predicted risk groups (p=0.0059, 0.0235, 0.0181, respectively). VI, TTV, TVR, MTV40 and TLG40 signi cantly predicted LVSI (p=0.0023, 0.0068, 0.0068, 0.0027, 0.0139, respectively). Imaging was not able to predict grading, MI nor p53 hyper-expression.Conclusion. 18F-FDG-PET/MRI has good accuracy in preoperative staging of EC; PET and MRI parameters have synergic role in preoperatively predicting LVSI, with MRI parameters being also predictive for EC risk groups.

A Single-center Prospective Observational Study Investigating the Accuracy of Preoperative Diagnostic Procedures in the Assessment of Lymph Node Metastases in Nonfunctioning Pancreatic Neuroendocrine Tumors

“…Second, the study design did not routinely include 18 F-FDG PET imaging that could have been associated with positive lesions at least in the small fraction of patients affected by high grade tumors. Third, despite some recent evidence have suggested a possible role for specific texture features in predicting nodal status, 26,28,43,44 this specific and innovative approach for image analysis has not been performed on a CE-CT or PET. Finally, long-term outcomes are still missing and the impact on prognosis of imaging findings is unknown.…”

“…CE-CT and EUS study protocols were previously described 26,27. 68Ga-DOTATOC PET images were acquired as previously described, by using a PET/CT or PET/ magnetic resonance imaging scanner 28…”

“…26,27 68Ga-DOTATOC PET images were acquired as previously described, by using a PET/ CT or PET/ magnetic resonance imaging scanner. 28 All CE-CT, EUS, and 68 Ga-DOTATOC PET imaging studies have been qualitatively assessed by 2 radiologists, 2 endoscopists, and 2 nuclear medicine physicians, respectively. In case of disagreement between the two readers, a third observer solved this.…”

Value of Molecular Typing Combined with Integrated Positron Emission Tomography/Magnetic Resonance Imaging in Risk Stratification of Endometrial Cancer

“…The value of PET/MRI in preoperative staging, evaluation of myometrial invasion, cervical interstitial infiltration, lymph node metastasis and distant metastasis, as well as evaluation and prognosis of endometrial cancer has been gradually confirmed. 21 Integrated PET/MRI can not only achieve preoperative staging of endometrial cancer, but also provide metabolic information of tumors and detect early lesions in addition to ensuring precise anatomical localization, while conventional imaging examinations are mainly based on morphological change. 22 Therefore, it provides important reference data for clinicians to determine the extent of surgical resection, guide postoperative radiotherapy and chemotherapy, guide the formulation of radiotherapy scope, and assess the prognosis of patients.…”

Role of Machine Learning (ML)-Based Classification Using Conventional 18F-FDG PET Parameters in Predicting Postsurgical Features of Endometrial Cancer Aggressiveness

“…18 Ffluoro-deoxyglucose ( 18 F-FDG) positron emission tomography (PET) has a well-established role in the preoperative staging of EC patients, and it is included in the clinical guidelines on EC management [24,25]. Precisely, 18 F-FDG is useful in providing a whole-body assessment of the disease, therefore identifying possible LN involvement and distant metastases [26][27][28][29][30].…”