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Functional Images Reflect Aggressiveness of Endometrial Carcinoma: Estrogen Receptor Expression Combined with ¹⁸F-FDG PET

¹ Biomedical Imaging Research Center, Faculty of Medical Sciences, University of Fukui, Fukui, Japan; ² Department of Gynecology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan; and ³ Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan

Correspondence: For correspondence or reprints contact: Hidehiko Okazawa, Biomedical Imaging Research Center, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Fukui 910-1193, Japan. E-mail: okazawa{at}u-fukui.ac.jp

The grade of histologic differentiation is one of the most important prognostic factors in patients with endometrial carcinoma and postoperative staging. The aim of this study was to investigate whether 16-¹⁸F-fluoro-17β-estradiol (¹⁸F-FES) and ¹⁸F-FDG PET reflect clinicopathologic features in patients with endometrial tumors. Methods: A total of 22 patients with endometrial adenocarcinoma and 9 with endometrial hyperplasia (mean age, 56.0 ± 15.3 y) underwent ¹⁸F-FES PET for estrogen receptor imaging and ¹⁸F-FDG PET. Regional values of tracer uptake were evaluated using standardized uptake value (SUV) and the SUV ratio of ¹⁸F-FDG to ¹⁸F-FES. The accuracy for predicting tumor aggressiveness defined as high-risk carcinoma (International Federation of Gynecology and Obstetrics [FIGO] stage Ic or histologic grade 2), low-risk carcinoma (FIGO stage Ib and grade 1), and hyperplasia was compared for each PET parameter using receiver-operating-characteristic (ROC) analysis. The diagnostic accuracy of MRI findings for clinical staging was also compared. Results: Although the SUV for ¹⁸F-FDG was significantly lower in endometrial hyperplasia than in carcinoma, a significant difference between high-risk and low-risk carcinoma was observed only in SUV for ¹⁸F-FES. High-risk carcinoma showed a significantly greater ¹⁸F-FDG–to–¹⁸F-FES ratio (3.6 ± 2.1) than did low-risk carcinoma (1.3 ± 0.5, P < 0.01) and hyperplasia (0.3 ± 0.1, P < 0.005). Low-risk carcinoma showed a significantly higher ¹⁸F-FDG–to–¹⁸F-FES ratio than hyperplasia (P < 0.0001). In ROC analysis, the most accurate diagnostic PET parameter for predicting high-risk and low-risk carcinoma was the ¹⁸F-FDG–to–¹⁸F-FES ratio. The optimal ¹⁸F-FDG/¹⁸F-FES cutoff value of 2.0, determined by ROC analysis, revealed 73% sensitivity, 100% specificity, and 86% accuracy, which was better than the 77% accuracy for MRI. The ¹⁸F-FDG–to–¹⁸F-FES ratio of 0.5 yielded a correct diagnosis for carcinoma from hyperplasia with 100% accuracy. Conclusion: Endometrial carcinoma reduces estrogen dependency with accelerated glucose metabolism as it progresses to a higher stage or grade. ¹⁸F-FES and ¹⁸F-FDG PET studies provide a new index of the ¹⁸F-FDG–to–¹⁸F-FES ratio, which is considered the most informative index reflecting tumor aggressiveness. This index will be useful for making noninvasive diagnoses and deciding the appropriate therapeutic strategy for patients with endometrial carcinoma.

Key Words: estrogen receptor • endometrial carcinoma • PET • glucose metabolism • tumor aggressiveness

COPYRIGHT © 2009 by the Society of Nuclear Medicine, Inc.

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