Department of Nuclear Medicine, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Radiology, FUWAI Central China Cardiovascular Hospital, Zhengzhou, China.
J Gynecol Oncol. 2019 Nov;30(6):e89. doi: 10.3802/jgo.2019.30.e89.
To investigate the prognostic value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG), measured by preoperative ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT), in risk stratification of patients with endometrial carcinoma (EC).
The patients with pathological diagnosis of EC who underwent preoperative ¹⁸F-FDG PET/CT imaging were retrospectively selected for analysis of the prognostic values of PET parameters in risk classification and lymph node metastases (LNMs). Receiver-operating-characteristic analysis was used to analyze the correlation of PET parameters cutoff values with deep myometrial invasion (MI), lymphovascular space involvement and LNM for prognostic values in risk stratification.
The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for detection of LNM are 83.3%, 99.7%, 90.9%, 99.5% and 99.2%, respectively. The MTV and TLG of primary lesion of EC in the patients with LNM are notably higher than those in patients without LNM, p<0.010. The MTV and TLG of the EC primary lesions in high-risk patients are significantly higher than those in low-risk patients (p<0.010), but the maximum standardized uptake value (SUVmax) is not. The MTV and TLG of primary lesions were superior to SUVmax for predicting of deep MI, LNM and high-risk of EC (p<0.005).
MTV and TLG of primary lesions are more valuable in predicting risk stratification of EC patients. Preoperative ¹⁸F-FDG PET/CT imaging is useful in predicting the LNM of EC and may help guide pelvic lymphadenectomy to avoid unnecessary pelvic lymphadenectomy in EC patients with low-risk stratification.
探讨术前 ¹⁸F-氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（¹⁸F-FDG PET/CT）测量的代谢肿瘤体积（MTV）和总肿瘤糖酵解（TLG）在子宫内膜癌（EC）患者风险分层中的预后价值。
回顾性分析经病理诊断为 EC 且行术前 ¹⁸F-FDG PET/CT 成像的患者，分析 PET 参数在风险分类和淋巴结转移（LNM）中的预后价值。采用受试者工作特征分析（ROC）分析 PET 参数截断值与深肌层浸润（MI）、脉管间隙浸润和 LNM 的相关性，以评估其在风险分层中的预后价值。
LNM 检测的灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为 83.3%、99.7%、90.9%、99.5%和 99.2%。LNM 患者 EC 原发灶的 MTV 和 TLG 明显高于无 LNM 患者（p<0.010）。高危患者的 EC 原发灶 MTV 和 TLG 明显高于低危患者（p<0.010），而最大标准化摄取值（SUVmax）则不然。MTV 和 TLG 对预测 EC 深部 MI、LNM 和高危的价值优于 SUVmax（p<0.005）。
原发灶 MTV 和 TLG 对预测 EC 患者的风险分层更有价值。术前 ¹⁸F-FDG PET/CT 成像有助于预测 EC 的 LNM，可能有助于指导盆腔淋巴结清扫术，避免低危分层 EC 患者不必要的盆腔淋巴结清扫术。
