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

Abstract

Background Postoperative pathologic risk factors (PRFs) could increase the recurrence rate in early-stage uterine cervical squamous cancer (ECSC). Our study intended to explore the efficiency of 18F-FDG PET/CT for assessing the pathologic risk status (PRS) in ECSC patients. Methods This retrospective study was performed in 240 ECSC patients with stage IA2-IIA2 (FIGO 2009), who underwent preoperative PET/CT scans and subsequent radical surgery between January 2010 and July 2015. Intermediate-risk (tumour diameter ≥ 4 cm, stromal invasion depth ≥ 1/2, lymphovascular space invasion (LVSI)), and high-risk factors (parametria involvement, positive surgery margin, pelvic lymph node metastasis) were confirmed by postoperative pathology. Patients with none of these PRFs were at a low risk for relapse. One of these PRFs was defined as positive risk. The relationship between each PRF and 18F-FDG uptake was analysed by t-test. Chi-square tests and logistic regression analyses were used to determine the efficiency of PET/CT parameters for assessing the PRS. The area under the curve (AUC) was used as an indicator for predictive efficiency. Results Patients with higher SUVmax (p < 0.001), MTV (p < 0.001) and TLG (p < 0.001) had larger tumour sizes and deeper stromal invasion. Further multivariate analyses showed SUVmax and TLG were independent predictors for positive- and intermediate-risk status. In high-risk group, MTV and TLG were associated with pelvic lymph node metastasis and parametria involvement. However, only MTV was a significant indicator. Conclusions Preoperative 18F-FDG PET/CT had an independent predictive value for PRS in ECSC.

Preoperative imaging with positron emission tomography and computed tomography (18F-FDG PET/CT) or contrast-enhanced computed tomography (CECT) scan in operable cervical cancer: a prospective study

“…This metabolic parameter is unavailable in conventional CECT scans and provides complementary information. Our SUV results are concordant with several other studies, which have also shown that this parameter in the primary tumor is an adverse prognostic factor and is associated with lymph node involvement and other features of biologically aggressive malignancy [19][20][21][22]. Given the higher spatial resolution of CECT or MRI and the metabolic information available with PET, the best imaging in clinically early-stage patients may be a combination of PET/CT and CECT or MRI.…”

Recurrence risk stratification for locally advanced cervical cancer using multi-modality transformer network

“…The specific reason is that the patients included in this study were all patients who had not undergone surgery, and there was no gold standard (pathological result) to verify the presence of lymph node metastasis. Previous studies ( 18 , 19 ) have also shown that it is sufficient to use only the imaging information of primary lesions for cancer prognosis analysis, and the method selection of this study is generally in line with the previous research norms.…”

“…Additionally, CT and MR images can provide information of tumors, such as lesion size and invasion degree, which is crucial for preliminary clinical staging and prognosis evaluation ( 47 – 51 ). Therefore, many models based on CT or MR images have been proposed for the subtype identification ( 52 ), staging analysis ( 53 , 54 ), lymph node metastasis prediction ( 54 , 55 ) and prognosis analysis ( 12 , 56 , 57 ) of cervical cancer. Compared to the above methods, the main contributions of this paper lie in the following aspects: (I) We first investigated the feasibility of deep learning method in accurately predicting recurrence risk so as to help formulate the individualized therapeutic schedule for LACC patients.…”

MRI-based radiomics analysis improves preoperative diagnostic performance for the depth of stromal invasion in patients with early stage cervical cancer

“…PET/CT is not an ideal method for diagnosing DOI due to its high false-positivity rate of 40.8% [ 15 ]. Previous studies have found that some clinical characteristics, including tumor diameter on imaging, were associated with the DOI in patients with early stage CC, but their value in preoperative diagnosis of middle or deep 1/3 stromal invasion is yet to be investigated [ 16 , 17 ].…”