Preoperative imaging markers and PDZ-binding kinase tissue expression predict low-risk disease in endometrial hyperplasias and low grade cancers

Abstract

PurposeDistinguishing complex atypical hyperplasia (CAH) from grade 1 endometrioid endometrial cancer (EECG1) preoperatively may be valuable in order to prevent surgical overtreatment, particularly in patients wishing preserved fertility or in patients carrying increased risk of perioperative complications.Material and methodsPreoperative histological diagnosis and radiological findings were compared to final histological diagnosis in patients diagnosed with CAH and EECG1. Imaging characteristics at preoperative magnetic resonance imaging (MRI) and fluorodeoxyglucose positron emission tomography/computer tomography (FDG-PET/CT) were compared with tumor DNA oligonucleotide microarray data, immunohistochemistry findings and clinicopathological annotations.ResultsMRI assessed tumor volume was higher in EECG1 than in CAH (p=0.004) whereas tumor apparent diffusion coefficient value was lower in EECG1 (p=0.005). EECG1 exhibited increased metabolism with higher maximum and mean standard uptake values (SUV) than CAH (p≤0.002). Unsupervised clustering of EECG1 and CAH revealed differentially expressed genes within the clusters, and identified PDZ-binding kinase (PBK) as a potential marker for selecting endometrial lesions with less aggressive biological behavior.ConclusionBoth PBK expression and preoperative imaging yield promising biomarkers that may aid in the differentiation between EECG1 and CAH preoperatively, and these markers should be further explored in larger patient series.

18F-FDG PET/CT Quantitative Parameters and Texture Analysis Effectively Differentiate Endometrial Precancerous Lesion and Early-Stage Carcinoma

“…Berg et al 9 showed that SUVmax and SUVmean were significantly lower in patients with CAH compared to those with grade 1 endometrial carcinoma (EECG1; P < .01), with AUCs of 0.87 and 0.97, respectively. By contrast, MTV did not significantly differ between CAH and EECG1 ( P = .1).…”

“…Preoperative diagnosis and staging of EC often uses 18 F-FDG PET/CT imaging, 20 but little research has been done on differentiating between precancerous lesions and early-stage cancer. 9,20,21 Although the SUV-related metabolic indices of PET are easy to obtain, the statistical method is based on Poisson distribution, which may affect measurement accuracy. Our experimental results revealed that there was a partial overlap of SUV-related parameters in precancerous lesions and early-stage cancer, some of which were difficult to discriminate between.…”

“…The most commonly used semiquantitative parameter of PET-maximum standard uptake value (SUVmax) is useful for diagnosing EAH and EC. 9 SUVmax represents the highest metabolic activity in the lesion, whereas MTV and total lesion glycolysis (TLG) reflect the overall metabolic activity in the lesion; MTV and TLG are more conducive to risk stratification for EC than SUVmax. 10 The peak standardized uptake value (SUVpeak) parameter represents the maximum value of the average SUV in a small spherical volume (10-mm diameter) and is more reliable and powerful than SUVmax and less subject to image noise.…”

RNF183 Is a Prognostic Biomarker and Correlates With Tumor Purity, Immune Infiltrates in Uterine Corpus Endometrial Carcinoma

“…By contrast, type I endometrial cancer is often endometrioid and well-differentiated, presumably owing to greater exposure to a long history of unopposed estrogen or other risk factors inducing hyperestrogenism such as obesity. Endometrial cancer is one of the few human malignant tumors for which mortality is increasing (Berg et al, 2017), which underlines the urgency to develop more effective methods for the early diagnosis and treatment of this disease.…”

Plasma growth differentiation factor-15 is an independent marker for aggressive disease in endometrial cancer

“…MRI has been reported to outperform that of endocervical curettage for preoperative prediction of cervical stromal invasion [29]. Also, for differentiation of low grade endometrial cancer from endometrial hyperplasia, preoperative MRI and FDG-PET yield promising imaging markers [30]. Imaging markers may thus be better than plasma GDF-15 in detecting early disease since the elevation of GDF-15 seems to occur prior to cancer development.…”