Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-8509, Japan.
Oncol Rep. 2010 Apr;23(4):1069-76. doi: 10.3892/or_00000734.
We evaluated the use of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) for the diagnosis of uterine sarcomas. FDG-PET combined with serum lactate dehydrogenase (LDH) levels were compared with FDG-PET alone for the diagnosis of leiomyosarcomas (LMS), which are the most difficult uterine sarcomas to diagnose. FDG-PET imaging of endometrial cancer (EC) was used as a reference. Immunoreactivity for glucose transporter-1 (GLUT-I) correlated with FDG uptake was evaluated in sarcomas and leiomyomas (LM), including cases not examined by FDG-PET. FDG was injected after at least 5 h fasting and standardized uptake values (SUVs) were analyzed quantitatively 50-70 min after injection. Immunohistochemical expression of GLUT-1 was studied in paraffin sections of tumors using anti-GLUT-1 antibodies and GLUT-1 expression scores were derived based on staining intensities. FDG-PET was performed preoperatively in a total of 53 patients including 10 with sarcomas, 19 with EC and 24 with LM. Immunohistochemical examination was performed in 17 sarcomas, 6 EC and 9 LM [6 usual LM, 1 uterine smooth muscle tumor of uncertain malignant potential (UMP), and 2 bizarre LM (BLM)]. SUVs for uterine sarcomas and EC were significantly higher (p=0.0001) than those for LMs. There were no significant differences in SUVs among ECs, carcinosarcomas (CS) and LMS. Significant differences in SUVs existed between LM and LMS (p=0.003). However, the diagnostic accuracy for LMS was only 73%. The diagnostic accuracy of FDG-PET combined with serum LDH was 100%. GLUT-1 expression scores were significantly higher in sarcomas and EC than in LM (p<0.0001). Intermediate GLUT-1 scores were found in two of the three cases of UMP and BLM. In conclusion, FDG-PET is useful for diagnosing uterine sarcomas, while FDG-PET combined with serum LDH is useful for diagnosing LMS. Immunohistochemical examination of GLUT-1 confirmed the high FDG uptake in LMS patients.
我们评估了 18F-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）在子宫肉瘤诊断中的应用。将 FDG-PET 联合血清乳酸脱氢酶（LDH）水平与单独 FDG-PET 进行比较，用于诊断最难以诊断的平滑肌肉瘤（LMS）。将子宫内膜癌（EC）的 FDG-PET 成像用作参考。评估了葡萄糖转运蛋白-1（GLUT-I）在肉瘤和肌瘤（LM）中的免疫反应性与 FDG 摄取的相关性，包括未进行 FDG-PET 检查的病例。在至少禁食 5 小时后注射 FDG，并在注射后 50-70 分钟进行定量标准化摄取值（SUV）分析。使用抗 GLUT-1 抗体在肿瘤的石蜡切片上研究 GLUT-1 的免疫组织化学表达，并根据染色强度得出 GLUT-1 表达评分。在总共 53 例患者中进行了术前 FDG-PET，包括 10 例肉瘤、19 例 EC 和 24 例 LM。对 17 例肉瘤、6 例 EC 和 9 例 LM（6 例普通 LM、1 例子宫平滑肌肿瘤恶性潜能不确定（UMP）和 2 例奇异 LM（BLM））进行了免疫组织化学检查。子宫肉瘤和 EC 的 SUV 值明显高于 LM（p=0.0001）。EC、癌肉瘤（CS）和 LMS 之间的 SUV 值没有显著差异。LM 和 LMS 之间的 SUV 值存在显著差异（p=0.003）。然而，LMS 的诊断准确性仅为 73%。FDG-PET 联合血清 LDH 的诊断准确性为 100%。肉瘤和 EC 的 GLUT-1 表达评分明显高于 LM（p<0.0001）。在 3 例 UMP 和 BLM 中，有 2 例的中间 GLUT-1 评分。总之，FDG-PET 可用于诊断子宫肉瘤，而 FDG-PET 联合血清 LDH 可用于诊断 LMS。GLUT-1 的免疫组织化学检查证实了 LMS 患者 FDG 的高摄取。
