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

  • 1Department of Nuclear Medicine, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. chmarka@163.com
  • 2Department of Radiology, FUWAI Central China Cardiovascular Hospital, Zhengzhou, China.
  • 3Department of Gynecology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
  • 4Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.


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).
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.
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 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.


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

MeSH Terms

Endometrial Neoplasms*
Lymph Node Excision
Lymph Nodes*
Lymphatic Metastasis
Neoplasm Metastasis*
Positron-Emission Tomography and Computed Tomography*
Retrospective Studies
Risk Assessment
Sensitivity and Specificity
Tumor Burden*
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