Mohn Medical Imaging and Visualization Centre (MMIV), Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, 5021, Bergen, Norway.
Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Eur Radiol. 2020 May;30(5):2443-2453. doi: 10.1007/s00330-019-06622-w. Epub 2020 Feb 7.
To compare the diagnostic accuracy of preoperative 18F-FDG PET/CT and MRI tumor markers for prediction of lymph node metastases (LNM) and aggressive disease in endometrial cancer (EC).
Preoperative whole-body 18F-FDG PET/CT and pelvic MRI were performed in 215 consecutive patients with histologically confirmed EC. PET/CT-based tumor standardized uptake value (SUV and SUV), metabolic tumor volume (MTV), and PET-positive lymph nodes (LNs) (SUV > 2.5) were analyzed together with the MRI-based tumor volume (V), mean apparent diffusion coefficient (ADC), and MRI-positive LN (maximum short-axis diameter ≥ 10 mm). Imaging parameters were explored in relation to surgicopathological stage and tumor grade. Receiver operating characteristic (ROC) curves were generated yielding optimal cutoff values for imaging parameters, and regression analyses were used to assess their diagnostic performance for prediction of LNM and progression-free survival.
For prediction of LNM, MTV yielded the largest area under the ROC curve (AUC) (AUC = 0.80), whereas V had lower AUC (AUC = 0.72) (p = 0.03). Furthermore, MTV > 27 ml yielded significantly higher specificity (74%, p < 0.001) and accuracy (75%, p < 0.001) and also higher odds ratio (12.2) for predicting LNM, compared with V > 10 ml (58%, 62%, and 9.7, respectively). MTV > 27 ml also tended to yield higher sensitivity than PET-positive LN (81% vs 50%, p = 0.13). Both V > 10 ml and MTV > 27 ml were significantly associated with reduced progression-free survival.
Tumor markers from 18F-FDG PET/CT outperform MRI markers for the prediction of LNM. MTV > 27 ml yields a high diagnostic performance for predicting aggressive disease and represents a promising supplement to conventional PET/CT reading in EC.
• Metabolic tumor volume (MTV) outperforms other 18F-FDG PET/CT and MRI markers for preoperative prediction of lymph node metastases (LNM) in endometrial cancer patients. • Using cutoff values for tumor volume for prediction of LNM, MTV > 27 ml yielded higher specificity and accuracy than V> 10 ml. • MTV represents a promising supplement to conventional PET/CT reading for predicting aggressive disease in EC.
比较术前 18F-FDG PET/CT 和 MRI 肿瘤标志物对子宫内膜癌（EC）淋巴结转移（LNM）和侵袭性疾病的诊断准确性。
对 215 例经组织学证实的 EC 患者进行了全身 18F-FDG PET/CT 和盆腔 MRI 检查。分析了基于 PET/CT 的肿瘤标准化摄取值（SUV 和 SUV）、代谢肿瘤体积（MTV）和 PET 阳性淋巴结（SUV>2.5），以及基于 MRI 的肿瘤体积（V）、平均表观扩散系数（ADC）和 MRI 阳性淋巴结（最大短轴直径≥10mm）。探讨了影像学参数与手术病理分期和肿瘤分级的关系。生成了受试者工作特征（ROC）曲线，得出了影像学参数的最佳截断值，并进行了回归分析，以评估其对 LNM 和无进展生存率预测的诊断性能。
对于预测 LNM，MTV 产生的 ROC 曲线下面积（AUC）最大（AUC=0.80），而 V 的 AUC 较低（AUC=0.72）（p=0.03）。此外，与 V>10ml（74%，p<0.001）和准确性（75%，p<0.001）相比，MTV>27ml 预测 LNM 的特异性（74%，p<0.001）和准确性（75%，p<0.001）也更高，也具有更高的优势比（12.2）。与 PET 阳性淋巴结（81%比 50%，p=0.13）相比，MTV>27ml 也倾向于产生更高的敏感性。V>10ml 和 MTV>27ml 均与无进展生存率降低显著相关。
18F-FDG PET/CT 的肿瘤标志物在预测 LNM 方面优于 MRI 标志物。MTV>27ml 对预测侵袭性疾病具有较高的诊断性能，是 EC 常规 PET/CT 阅读的有前途的补充。
代谢肿瘤体积（MTV）在预测子宫内膜癌患者的淋巴结转移（LNM）方面优于其他 18F-FDG PET/CT 和 MRI 标志物。
使用肿瘤体积预测 LNM 的截断值，MTV>27ml 比 V>10ml 具有更高的特异性和准确性。
MTV 是预测 EC 侵袭性疾病的一种很有前途的常规 PET/CT 阅读的补充方法。
