J Gynecol Oncol.  2019 Nov;30(6):e89. 10.3802/jgo.2019.30.e89.

Prognostic value of metabolic tumor volume and total lesion glycolysis from ¹⁸F-FDG PET/CT in lymph node metastases and risk stratification of endometrial carcinoma

• Liu DD
• Li J
• Li X
• Xie L
• Qin L
• Peng F
• Cheng MH

• KMID: 2458896
• DOI: http://doi.org/10.3802/jgo.2019.30.e89

Abstract

OBJECTIVE
To investigate the prognostic value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG), measured by preoperative ¹â¸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹â¸F-FDG PET/CT), in risk stratification of patients with endometrial carcinoma (EC).
METHODS
The patients with pathological diagnosis of EC who underwent preoperative ¹â¸F-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.
RESULTS
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).
CONCLUSION
MTV and TLG of primary lesions are more valuable in predicting risk stratification of EC patients. Preoperative ¹â¸F-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.

Keyword

Endometrial Carcinoma; Lymphatic Metastases; Tumor Volume; Metabolism; Risk Assessment

MeSH Terms

Classification
Diagnosis
Electrons
Endometrial Neoplasms*
Female
Glycolysis*
Humans
Lymph Node Excision
Lymph Nodes*
Lymphatic Metastasis
Metabolism
Neoplasm Metastasis*
Positron-Emission Tomography and Computed Tomography*
Retrospective Studies
Risk Assessment
Sensitivity and Specificity
Tumor Burden*

Figure

• 

  Fig. 1. A high-risk EC patient, 55 years, EC G3, FIGO stage IIIC1, with positive LNM and LVSI. The SUVmax, MTV and TLG of primary lesion (A) are 22.39, 61.24 and 589.74, respectively. The SUVmax in left external iliac LNM (B) is 5.34, more than the 5.22 of cutoff value, confirmed as LNM, but the SUVmax in left common iliac lymph node (C) is 4.05, less than the 5.22 of cutoff value, confirmed as negative LNM by pathology. EC, endometrial carcinoma; FIGO, International Federation of Gynecology and Obstetrics; LNM, lymph node metastasis; LVSI, lymphovascular space involvement; MTV, metabolic tumor volume; SUVmax, maximum standardized uptake value; TLG, total lesion glycolysis.

• 

  Fig. 2. ROC curves for various tumor quantifications for prediction of MI (A), LNMs (B), LVSI (C) and risk stratification (D) in patients with endometrial carcinoma. The p-values refer to test of equal areas under the curve across tumor quantifications AUCs. AUC, area under the curve; LNM, lymph node metastasis; LVSI, lymphovascular space involvement; MI, myometrial invasion; MTV, metabolic tumor volume; ROC, receiver-operating-characteristic; SUV, standardized uptake value; TLG, total lesion glycolysis.

Reference

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