Published in:
01-01-2006 | Original Article
18F-FDG PET in the management of endometrial cancer
Authors:
Angel Chao, Ting-Chang Chang, Koon-Kwan Ng, Swei Hsueh, Huei-Jean Huang, Hung-Hsueh Chou, Chien-Sheng Tsai, Tzu-Chen Yen, Tzu-I Wu, Chyong-Huey Lai
Published in:
European Journal of Nuclear Medicine and Molecular Imaging
|
Issue 1/2006
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Abstract
Purpose
Few studies have investigated the clinical impact of whole-body positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) in endometrial cancer. We aimed to assess the value of integrating FDG-PET into the management of endometrial cancer in comparison with conventional imaging alone.
Methods
All patients with histologically confirmed primary advanced (stage III/IV) or suspicious/documented recurrent endometrial cancer, with poor prognostic features (serum CA-125 >35 U/ml or unfavourable cell types), or surveillance after salvage therapy were eligible. Before FDG-PET scanning, each patient had received magnetic resonance imaging and/or computed tomography (MRI-CT). The receiver operating characteristic curve method with calculation of the area under the curve (AUC) was used to compare the diagnostic efficacy. Clinical impacts were determined on a scan basis.
Results
Forty-nine eligible patients were accrued and 60 studies were performed (27 primary staging, 33 post-therapy surveillance or restaging on relapse). The clinical impact was positive in 29 (48.3%) of the 60 scans. Mean standardised uptake values (SUVs) of true-positive lesions were 13.2 (range 5.7–37.4) for central pelvic lesions and 11.1 (range 1.5–37.4) for metastases. The sensitivity of FDG-PET alone (P<0.0001) or FDG-PET plus MRI-CT (P<0.0001) was significantly higher than that of MRI-CT alone in overall lesion detection. FDG-PET plus MRI-CT was significantly superior to MRI-CT alone in overall lesion detection (AUC 0.949 vs 0.872; P=0.004), detection of pelvic nodal/soft tissue metastases (P=0.048) and detection of extrapelvic metastases (P=0.010), while FDG-PET alone was only marginally superior by AUC (P=0.063).
Conclusion
Whole-body FDG-PET coupled with MRI-CT facilitated optimal management of endometrial cancer in well-selected cases.