Kitajima Kazuhiro, Suenaga Yuko, Ueno Yoshiko, Maeda Tetsuo, Ebina Yasuhiko, Yamada Hideto, Okunaga Takashi, Kubo Kazuhiro, Sofue Keitarou, Kanda Tomonori, Tamaki Yukihisa, Sugimura Kazuro
Department of Radiology, Kobe University School of Medicine, Kobe, Japan,
Eur J Nucl Med Mol Imaging. 2015 Jul;42(8):1268-75. doi: 10.1007/s00259-015-3037-2. Epub 2015 Apr 2.
To evaluate the usefulness of metabolic parameters obtained by (18)F-FDG PET/CT for preoperative stratification of high-risk and low-risk endometrial carcinomas.
Preoperative (18)F-FDG PET/CT was performed in 56 women with endometrial cancer. Maximum standardized uptake values (SUVmax), metabolic tumour volume (MTV) and total lesion glycolysis (TLG) of primary tumours were compared with clinicopathological features of surgical specimens. Diagnostic performance in terms of differentiation of low-risk disease (endometrioid histology, histological grade 1 or 2, invasion of less than half of the myometrium, and FIGO stage I) from high-risk disease was assessed.
MTV and TLG were significantly higher in patients with higher histological grade (p = 0.0026 and p = 0.034), larger tumour size (p = 0.002 and p = 0.0017), lymphovascular space involvement (LVSI; p = 0.012 and p = 0.0051), myometrial invasion (p = 0.027 and p = 0.031), cervical stromal invasion (p = 0.023 and p = 0.014), ovarian metastasis (p = 0.00022 and p = 0.00034), lymph node metastasis (p < 0.0001 and p < 0.0001), and higher FIGO stage (p = 0.0011 and p = 0.00048). SUVmax was significantly higher in patients with larger tumour size (p = 0.0025), LVSI (p = 0.00023) and myometrial invasion (p < 0.0001). The areas under the ROC curves (AUCs) for distinguishing high-risk from low-risk carcinoma were 0.625, 0.829 and 0.797 for SUVmax, MTV and TLG, respectively. AUCs for both MTV and TLG were significantly larger than that for SUVmax (p = 0.0049 and p = 0.021). The optimal TLG cut-off value of 70.2, determined by ROC analysis, was found to have 72.0% sensitivity and 74.2% specificity for risk stratification.
MTV and TLG of primary endometrial cancer show better correlations with clinicopathological features and are more useful for differentiating high-risk from low-risk carcinoma than SUVmax.
评估通过¹⁸F-FDG PET/CT获得的代谢参数对子宫内膜癌术前高风险和低风险分层的作用。
对56例子宫内膜癌女性患者进行术前¹⁸F-FDG PET/CT检查。将原发性肿瘤的最大标准化摄取值（SUVmax）、代谢肿瘤体积（MTV）和总病变糖酵解（TLG）与手术标本的临床病理特征进行比较。评估其在区分低风险疾病（子宫内膜样组织学、组织学1级或2级、肌层浸润小于一半、国际妇产科联盟（FIGO）I期）和高风险疾病方面的诊断性能。
组织学分级较高（p = 0.0026和p = 0.034）、肿瘤尺寸较大（p = 0.002和p = 0.0017）、存在淋巴管间隙浸润（LVSI；p = 0.012和p = 0.0051）、肌层浸润（p = 0.027和p = 0.031）、宫颈间质浸润（p = 0.023和p = 0.014）、卵巢转移（p = 0.00022和p = 0.00034）、淋巴结转移（p < 0.0001和p < 0.0001）以及FIGO分期较高（p = 0.0011和p = 0.00048）的患者，其MTV和TLG显著更高。肿瘤尺寸较大（p = 0.0025）、存在LVSI（p = 0.00023）和肌层浸润（p < 0.0001）的患者，其SUVmax显著更高。区分高风险和低风险癌的ROC曲线下面积（AUC），SUVmax、MTV和TLG分别为0.625、0.829和0.797。MTV和TLG的AUC均显著大于SUVmax的AUC（p = 0.0049和p = 0.021）。通过ROC分析确定的TLG最佳截断值为70.2，发现其在风险分层中的敏感性为72.0%，特异性为74.2%。
原发性子宫内膜癌的MTV和TLG与临床病理特征的相关性更好，在区分高风险和低风险癌方面比SUVmax更有用。
