18F-FDG PET in the management of endometrial cancer |
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| 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 |
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| Affiliation: | (1) Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan;(2) Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan;(3) Department of Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan;(4) Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan;(5) Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan;(6) Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan;(7) Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, 5 Fu-Shin Street, Kueishan, Taoyuan, 333, Taiwan |
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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.These data were presented in part at the Tenth Biennial Meeting of the International Gynecologic Cancer Society, Edinburgh, Scotland, October 3–7, 2004 |
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| Keywords: | 18F-FDG PET Endometrial cancer Primary staging Recurrence Salvage therapy |
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