Relationship of ¹⁸F-Fdg Pet/Ct Metabolic, Clinical and Pathological Characteristics of Primary Squamous Cell Carcinoma of the Cervix

Abstract

The objectives of this retrospective study were to use preoperative fluoro-d-glucose (FDG) PET/CT in patients with primary cervical squamous cell carcinoma to explore the relationship between clinical, pathological and metabolic characteristics. Eighty consecutive patients with squamous cell carcinoma of cervix received FDG PET/CT scan before treatment. Metabolic tumor volume (MTV), total lesion glycolysis (TLG) and the peak standardized uptake value (SUVpeak) of the cervical tumors were calculated by an iterative adaptive algorithm. The association of these metabolic markers with serum squamous cell carcinoma antigen (SCC-ag), International Federation of Gynecology and Obstetrics (FIGO) stage, maximum tumor size and depth of cervical stromal invasion of the tumor was determined by the multivariate analysis. MTV and TLG were significantly higher in subjects with serum SCC-ag levels ≥3.95, with FIGO stage 1b2 and with a maximum tumor size of ≥4 cm (p≤0.009). Higher SUVpeak levels were associated with a maximum tumor size of ≥4 cm and with a cervical stromal invasion depth of ≥1/2 (p≤0.003). Multivariate analysis indicated that MTV was independently associated with FIGO stage Ib2 (p=0.041) and depth of cervical stromal invasion (p=0.020). TLG and SUVpeak were independently associated with maximum tumor size (p≤0.004) and depth of cervical stromal invasion (p≤0.013). Significant linear correlation was found between SUVpeak and tumor size; the Pearson correlation coefficient was 0.34 (p=0.002). Metabolic parameters such as MTV, TLG and SUVpeak are able to predict clinical and pathological status in preoperative cervical cancer.

The feasibility of 18F-FDG PET/CT for predicting pathologic risk status in early-stage uterine cervical squamous cancer

“…Thus, we analysed the relationship between each PRF and PET/CT parameter in our study. The results showed that all PET/CT parameters, including SUVmax, MTV and TLG, were statistically associated with tumour size and deep stromal invasion, which was consistent with previous studies [ 17 , 18 ]. We also found in PET/CT that parametrial invasion and pelvic lymph node metastasis had significant relationships with MTV and TLG, but not SUVmax, even though magnetic resonance imaging (MRI) is the best technology for evaluating the invasion of the parametrium in uterine cervical cancer.…”

“…3 The relationships between 18 F-FDG uptake and parametria invasion and pelvic lymph node metastasis. For high-risk factor, MTV and TLG had significant relationships with parametria invasion (MTV: p < 0.001; TLG: p < 0.001) and pelvic lymph node metastasis (MTV: p < 0.001; TLG: p = 0.007) CT parameters, including SUVmax, MTV and TLG, were statistically associated with tumour size and deep stromal invasion, which was consistent with previous studies [17,18]. We also found in PET/CT that parametrial invasion and pelvic lymph node metastasis had significant relationships with MTV and TLG, but not SUVmax, even though magnetic resonance imaging (MRI) is the best technology for evaluating the invasion of the parametrium in uterine cervical cancer.…”

“…Metabolic tumour volume (MTV) and the mean value of SUV (SUVmean) were measured by drawing a contour large enough to encase the primary tumor in the axial, coronal, and sagittal PET images. A usually used threshold in clinical--SUV of 2.5 [16][17][18] was define as the margins. The voxel was automatically incorporated when the SUV exceeding the threshold of 2.5, then the MTV was produced.…”

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

“…We used an iterative adaptive algorithm provided by PET VCAR software that automatically delineated ROIs and generated measurement results, greatly reducing errors of manually delineated ROIs. 17 Nevertheless, we found it interesting that MTV and TLG had higher specificity and lower false positivity than other parameters in identifying EAH and EC. We performed linear regression modeling (lasso) of texture classification to analyze the discriminant ability of texture features extracted from samples.…”

“…Disagreements were resolved by consensus through negotiation. The SUVpeak, SUVmax, SUVmean, MTV, and TLG parameters were obtained for each endometrial lesion using the PET VCAR software, and the thresholds of delineating tumor edge and regions of interest (ROI) were determined automatically by iterative adaptive algorithm 17 (Figure 1). The physiological absorption regions (eg, intestinal canal, ureter, blood vessel) were not imaged.…”