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¹⁸F-FDG Uptake in Squamous Cell Carcinoma of the Cervix Is Correlated with Glucose Transporter 1 Expression

¹ Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
² Biostatistics Consulting Center/Department of Public Health, Chang Gung University, Taoyuan, Taiwan
³ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
⁴ Department of Human Genetics, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
⁵ Department of Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
⁶ Institute of Nuclear Energy Research, Taoyuan, Taiwan
⁷ Department of Pathology, Veterans General Hospital-Taipei
⁸ Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan

This prospective study investigates the relationship between glucose transporter-1 (Glut-1) expression and PET images using ¹⁸F-FDG and its uptake and compares them with the tumor status (primary vs. recurrent or persistent), initial grade of histologic differentiation, and International Federation of Gynecologic Obstetrics (FIGO) staging for cervical cancer patients. Methods: A dual-phase ¹⁸F-FDG PET scan was performed on 51 participants within the 2 wk before surgery or biopsy. ¹⁸F-FDG uptake was quantified by calculating standardized uptake values (SUVs). After ¹⁸F-FDG PET scanning, 51 histologically proven squamous cell carcinoma specimens were examined to determine their degree of differentiation, using hematoxylin and eosin staining, and the expression of Glut-1 by an immunohistochemical stain. Twenty normal cervical and 20 cervical intraepithelial neoplasia (CIN) sets of tissue were also used to compare the results of Glut-1 expression in these tissues. The expression of Glut-1 was the product of (the intensity [with grades 0–3, defined qualitatively]) with (percentages of the lesion area that were positive). The results of Glut-1 expression were analyzed in combination with the SUVs (SUV1 was that at 40 min and SUV2 was that at 3 h), tumor status, initial cell differentiation, and FIGO staging. Results: Significant overexpression of Glut-1 was noted in 48 of the 51 (94.1%) cancer specimens. None or only minimal expression of Glut-1 was observed in basal layers of normal and CIN tissues. Significant positive correlation was observed between Glut-1 expression and the SUVs in cervical cancer specimens (r = 0.74, P < 0.000 for SUV1 and r = 0.65, P < 0.000 for SUV2). In recurrent or persistent tumor, tumor size was significantly associated with both Glut-1 expression (r = 0.508, P = 0.011) and SUV1 (r = 0. 456, P = 0.025). For recurrent or persistent tumor, only SUV1 reached statistical significance when compared with lymph node metastasis (P = 0.0226). Conclusion: Glut-1 expression was related to ¹⁸F-FDG uptake in cervical cancer patients. Recurrent or persistent cervical cancer tumor had significantly higher Glut-1 expression than metastatic lymph nodes. The values of SUV and the expression of Glut-1 did not correlate with the initial grade of histologic differentiation and FIGO staging.

Key Words: glucose transporter 1 • squamous cell carcinoma • cervical cancer

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