Mapelli P, Bergamini A, Fallanca F, Rancoita P M V, Cioffi R, Incerti E, Rabaiotti E, Petrone M, Mangili G, Candiani M, Gianolli L, Picchio M
Vita-Salute San Raffaele University, Milan, Italy; Unit of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Unit of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Rev Esp Med Nucl Imagen Mol (Engl Ed). 2019 Jan-Feb;38(1):3-9. doi: 10.1016/j.remn.2018.06.007. Epub 2018 Dec 17.
To investigate the preoperative prognostic role of F-FDG PET/CT in patients with endometrial carcinoma (EC).
F-FDG PET/CT was performed in 57 patients for EC preoperative staging. Maximum and mean standardized uptake values (SUVmax, mean), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of primary tumors, at different thresholds of 40%, 50%, 60% (40-50-60), were evaluated and compared with anatomopathological features. The diagnostic performance of PET-parameters (categorized by ROC analysis) in discriminating low-intermediate and high-risk disease and the prognostic role on survival (overall survival -OS; disease free survival - DFS) was evaluated.
The categorized TLG40-50-60 were the only parameters related to FIGO stage I versus II-III-IV (p = 0.0035 for all). The cut-off values for risk stratification were 83.69, 61.81 and 41.32, respectively (sensitivity: 60.00%; specificity; 71.43% for all parameters). Pathological stage 1 (pT1) of the primary tumor was predicted by MTV60 and TLG40-50 (p = 0.0328, 0.0240, 0.0147, respectively). The optimal thresholds were 7.795, 99.55 and 77.58, respectively (sensitivity: 38.46%, 53.85% and 53.85%, respectively; specificity: 88.64%, 79.55% and 81.82%, respectively). SUVmax and SUVmean40-50-60 were the only parameters discriminating endometrioid from non-endometrioid subtype. The corresponding sensitivity was 64.86% and 62.16% for SUVmax and SUVmean 50-60 and 62.16% for SUVmean40; specificity was 70.00% for all parameters. The mean (SD) OS was 79.77% (3.34%) and the mean DFS was 77.89% (3.73%). The tumor type was the only variable significantly associated with OS (p = 0.0486). TLG50 > 77.58 cm was the only variable associated with a higher risk of relapse (p = 0.0472).
TLG40-50-60 and MTV60 of primary EC have prognostic value in discriminating FIGO and pathological staging. These results suggest a possible role of these parameters in predicting EC aggressiveness, thus improving the preoperative characterization of endometrial cancer.
探讨F-FDG PET/CT在子宫内膜癌（EC）患者术前的预后评估作用。
对57例EC患者进行F-FDG PET/CT检查以进行术前分期。评估原发肿瘤在40%、50%、60%（40-50-60）不同阈值下的最大和平均标准化摄取值（SUVmax、均值）、代谢肿瘤体积（MTV）和总病变糖酵解（TLG），并与解剖病理学特征进行比较。评估PET参数（通过ROC分析分类）在区分低-中危和高危疾病中的诊断性能以及对生存（总生存-OS；无病生存-DFS）的预后作用。
分类后的TLG40-50-60是唯一与FIGO I期与II-III-IV期相关的参数（所有参数p = 0.0035）。风险分层的临界值分别为83.69、61.81和41.32（所有参数的敏感性：60.00%；特异性：71.43%）。MTV60和TLG40-50可预测原发肿瘤的病理分期1（pT1）（分别为p = 0.0328、0.0240、0.0147）。最佳阈值分别为7.795、99.55和77.58（敏感性分别为：38.46%、53.85%和53.85%；特异性分别为：88.64%、79.55%和81.82%）。SUVmax和SUVmean40-50-60是区分子宫内膜样与非子宫内膜样亚型的唯一参数。SUVmax和SUVmean 50-
