Skip to main content
SpringerLink
Log in

The clinical impact of [18F]FDG PET/CT for the management of recurrent endometrial cancer: correlation with clinical and histological findings

  • Original article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to evaluate the accuracy of integrated positron emission tomography (PET) and computed tomography (CT) for the identification of suspected recurrent endometrial cancer after treatment.

Methods

Thirty-one women (median age, 53 years) with endometrial cancer treated by primary staging laparotomy who had [18F]fluorodeoxyglucose (FDG) PET/CT performed for suspected recurrence were retrospectively reviewed. The findings of the PET/CT scans were compared, with the histological examination after a surgical biopsy in 20 cases and with clinical follow-up in 11 cases to determine the diagnostic accuracy of PET/CT.

Results

Twelve (38.7%) of the 31 patients had a documented recurrence by surgical biopsy or clinical follow-up, and 19 (61.3%) had no evidence of recurrence. Of the 12 patients with recurrent disease, nine (75.0%) women were confirmed to have a recurrence by surgical biopsy. A close correlation was found between the PET/CT and histological or clinical analyses (κ = 0.933, p < 0.001). The overall sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and accuracy of PET/CT were 100, 94.7, 92.3, 100, and 96.8%, respectively. The PET/CT results modified the diagnostic or treatment plan in seven (22.6%) patients, resulting in five (16.1%) patients undergoing previously unplanned therapeutic procedures and eliminating previously planned diagnostic procedures in two (6.5%) patients. Patients with negative PET/CT scans showed significantly better progression-free survival than those with positive scans (p = 0.015).

Conclusion

Integrated PET/CT appears to be highly sensitive, specific, and accurate as a post-therapy surveillance modality for endometrial cancer in well-selected patients. The PET/CT might be used to improve patient surveillance and prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Rose PG. Endometrial carcinoma. N Engl J Med 1996;335:640–9.

    Article  PubMed  CAS  Google Scholar 

  2. Kurihara T, Mizunuma H, Obara M, Andoh K, Ibuki Y, Nishimura T. Determination of a normal level of serum CA125 in postmenopausal women as a tool for preoperative evaluation and postoperative surveillance of endometrial carcinoma. Gynecol Oncol 1998;69:192–6.

    Article  PubMed  CAS  Google Scholar 

  3. Hida J, Yasutomi M, Shindoh K, Kitaoka M, Fujimoto K, Ieda S, et al. Second-look operation for recurrent colorectal cancer based on carcinoembryonic antigen and imaging techniques. Dis Colon Rectum 1996;39:74–9.

    Article  PubMed  CAS  Google Scholar 

  4. Torizuka T, Nobezawa S, Kanno T, Futatsubashi M, Yoshikawa E, Okada H, et al. Ovarian cancer recurrence: role of whole-body positron emission tomography using 2-[fluorine-18]-fluoro-2-deoxy-d-glucose. Eur J Nucl Med Mol Imaging 2002;29:797–803.

    Article  PubMed  CAS  Google Scholar 

  5. Ebner F, Kressel HY, Mintz MC, Carlson JA, Cohen EK, Schiebler M, et al. Tumor recurrence versus fibrosis in the female pelvis: differentiation with MR imaging at 1.5 T. Radiology 1988;166:333–40.

    PubMed  CAS  Google Scholar 

  6. Kinkel K, Ariche M, Tardivon AA, Spatz A, Castaigne D, Lhomme C, et al. Differentiation between recurrent tumor and benign conditions after treatment of gynecologic pelvic carcinoma: value of dynamic contrast-enhanced subtraction MR imaging. Radiology 1997;204:55–63.

    PubMed  CAS  Google Scholar 

  7. Connor JP, Andrews JI, Anderson B, Buller RE. Computed tomography in endometrial carcinoma. Obstet Gynecol 2000;95:692–6.

    Article  PubMed  CAS  Google Scholar 

  8. Rohren EM, Turkington TG, Coleman RE. Clinical applications of PET in oncology. Radiology 2004;231:305–32.

    Article  PubMed  Google Scholar 

  9. Anzai Y, Carroll WR, Quint DJ, Bradford CR, Minoshima S, Wolf GT, et al. Recurrence of head and neck cancer after surgery or irradiation: prospective comparison of 2-deoxy-2-[F-18]fluoro-d-glucose PET and MR imaging diagnoses. Radiology 1996;200:135–41.

    PubMed  CAS  Google Scholar 

  10. Schelling M, Avril N, Nahrig J, Kuhn W, Romer W, Sattler D, et al. Positron emission tomography using [(18)F]Fluorodeoxyglucose for monitoring primary chemotherapy in breast cancer. J Clin Oncol 2000;18:1689–95.

    PubMed  CAS  Google Scholar 

  11. Chung HH, Kim SK, Kim TH, Lee S, Kang KW, Kim JY, et al. Clinical impact of FDG-PET imaging in post-therapy surveillance of uterine cervical cancer: from diagnosis to prognosis. Gynecol Oncol 2006;103:165–70.

    Article  PubMed  Google Scholar 

  12. Chung HH, Jo H, Kang WJ, Kim JW, Park NH, Song YS, et al. Clinical impact of integrated PET/CT on the management of suspected cervical cancer recurrence. Gynecol Oncol 2007;104:529–34.

    Article  PubMed  Google Scholar 

  13. Belhocine T, De Barsy C, Hustinx R, Willems-Foidart J. Usefulness of (18)F-FDG PET in the post-therapy surveillance of endometrial carcinoma. Eur J Nucl Med Mol Imaging 2002;29:1132–9.

    Article  PubMed  CAS  Google Scholar 

  14. Ryu SY, Kim MH, Choi SC, Choi CW, Lee KH. Detection of early recurrence with 18F-FDG PET in patients with cervical cancer. J Nucl Med 2003;44:347–52.

    PubMed  Google Scholar 

  15. Grigsby PW, Siegel BA, Dehdashti F, Rader J, Zoberi I. Posttherapy [18F] fluorodeoxyglucose positron emission tomography in carcinoma of the cervix: response and outcome. J Clin Oncol 2004;22:2167–71.

    Article  PubMed  Google Scholar 

  16. Charron M, Beyer T, Bohnen NN, Kinahan PE, Dachille M, Jerin J, et al. Image analysis in patients with cancer studied with a combined PET and CT scanner. Clin Nucl Med 2000;25:905–10.

    Article  PubMed  CAS  Google Scholar 

  17. Kluetz PG, Meltzer CC, Villemagne VL, Kinahan PE, Chander S, Martinelli MA, et al. Combined PET/CT Imaging in Oncology. Impact on Patient Management. Clin Positron Imaging 2000;3:223–30.

    Article  PubMed  Google Scholar 

  18. Makhija S, Howden N, Edwards R, Kelley J, Townsend DW, Meltzer CC. Positron emission tomography/computed tomography imaging for the detection of recurrent ovarian and fallopian tube carcinoma: a retrospective review. Gynecol Oncol 2002;85:53–8.

    Article  PubMed  CAS  Google Scholar 

  19. Chung HH, Kang WJ, Kim JW, Park NH, Song YS, Chung JK, et al. Role of [18F]FDG PET/CT in the assessment of suspected recurrent ovarian cancer: correlation with clinical or histological findings. Eur J Nucl Med Mol Imaging 2007;34:480–6.

    Article  PubMed  Google Scholar 

  20. Antoch G, Saoudi N, Kuehl H, Dahmen G, Mueller SP, Beyer T, et al. Accuracy of whole-body dual-modality fluorine-18-2-fluoro-2-deoxy-d-glucose positron emission tomography and computed tomography (FDG-PET/CT) for tumor staging in solid tumors: comparison with CT and PET. J Clin Oncol 2004;22:4357–68.

    Article  PubMed  Google Scholar 

  21. Metser U, Golan O, Levine CD, Even-Sapir E. Tumor lesion detection: when is integrated positron emission tomography/computed tomography more accurate than side-by-side interpretation of positron emission tomography and computed tomography. J Comput Assist Tomogr 2005;29:554–9.

    Article  PubMed  Google Scholar 

  22. Reinartz P, Wieres FJ, Schneider W, Schur A, Buell U. Side-by-side reading of PET and CT scans in oncology: which patients might profit from integrated PET/CT. Eur J Nucl Med Mol Imaging 2004;31:1456–61.

    Article  PubMed  Google Scholar 

  23. De Leyn P, Stroobants S, De Wever W, Lerut T, Coosemans W, Decker G, et al. Prospective comparative study of integrated positron emission tomography-computed tomography scan compared with remediastinoscopy in the assessment of residual mediastinal lymph node disease after induction chemotherapy for mediastinoscopy-proven stage IIIA-N2 Non-small-cell lung cancer: a Leuven Lung Cancer Group Study. J Clin Oncol 2006;24:3333–9.

    Article  PubMed  Google Scholar 

  24. Pelosi E, Messa C, Sironi S, Picchio M, Landoni C, Bettinardi V, et al. Value of integrated PET/CT for lesion localisation in cancer patients: a comparative study. Eur J Nucl Med Mol Imaging 2004;31:932–9.

    Article  PubMed  Google Scholar 

  25. Hubner KF, McDonald TW, Niethammer JG, Smith GT, Gould HR, Buonocore E. Assessment of primary and metastatic ovarian cancer by positron emission tomography (PET) using 2-[18F]deoxyglucose (2-[18F]FDG). Gynecol Oncol 1993;51:197–204.

    Article  PubMed  CAS  Google Scholar 

  26. Fleiss J. Statistical methods for rates and proportions. 2nd ed. New York: Willey; 1981.

    Google Scholar 

  27. Sugawara Y, Eisbruch A, Kosuda S, Recker BE, Kison PV, Wahl RL. Evaluation of FDG PET in patients with cervical cancer. J Nucl Med 1999;40:1125–31.

    PubMed  CAS  Google Scholar 

  28. Grigsby PW, Siegel BA, Dehdashti F, Mutch DG. Posttherapy surveillance monitoring of cervical cancer by FDG-PET. Int J Radiat Oncol Biol Phys 2003;55:907–13.

    PubMed  Google Scholar 

  29. Belhocine TZ. 18F-FDG PET imaging in posttherapy monitoring of cervical cancers: from diagnosis to prognosis. J Nucl Med 2004;45:1602–4.

    PubMed  Google Scholar 

  30. Sironi S, Messa C, Mangili G, Zangheri B, Aletti G, Garavaglia E, et al. Integrated FDG PET/CT in patients with persistent ovarian cancer: correlation with histologic findings. Radiology 2004;233:433–40.

    Article  PubMed  Google Scholar 

  31. Bristow RE, del Carmen MG, Pannu HK, Cohade C, Zahurak ML, Fishman EK, et al. Clinically occult recurrent ovarian cancer: patient selection for secondary cytoreductive surgery using combined PET/CT. Gynecol Oncol 2003;90:519–28.

    Article  PubMed  Google Scholar 

  32. Yen TC, Ng KK, Ma SY, Chou HH, Tsai CS, Hsueh S, et al. Value of dual-phase 2-fluoro-2-deoxy-d-glucose positron emission tomography in cervical cancer. J Clin Oncol 2003;21:3651–8.

    Article  PubMed  Google Scholar 

  33. Lai CH, Huang KG, See LC, Yen TC, Tsai CS, Chang TC, et al. Restaging of recurrent cervical carcinoma with dual-phase [18F]fluoro-2-deoxy-d-glucose positron emission tomography. Cancer 2004;100:544–52.

    Article  PubMed  Google Scholar 

  34. Chao A, Chang TC, Ng KK, Hsueh S, Huang HJ, Chou HH, et al. 18F-FDG PET in the management of endometrial cancer. Eur J Nucl Med Mol Imaging 2006;33:36–44.

    Article  PubMed  Google Scholar 

  35. Saga T, Higashi T, Ishimori T, Mamede M, Nakamoto Y, Mukai T, et al. Clinical value of FDG-PET in the follow up of post-operative patients with endometrial cancer. Ann Nucl Med 2003;17:197–203.

    Article  PubMed  Google Scholar 

  36. Rebollo-Aguirre AC, Ramos-Font C, Gallego Peinado M, Bellon-Guardia ME, Cabello Garcia D, Rodriguez-Fernandez A, et al. [Positron emission tomography with fluordesoxyglucose-F18 in follow-up of endometrial cancer]. Rev Esp Med Nucl 2006;25:359–66.

    Article  PubMed  CAS  Google Scholar 

  37. Horowitz NS, Dehdashti F, Herzog TJ, Rader JS, Powell MA, Gibb RK, et al. Prospective evaluation of FDG-PET for detecting pelvic and para-aortic lymph node metastasis in uterine corpus cancer. Gynecol Oncol 2004;95:546–51.

    Article  PubMed  Google Scholar 

  38. Suzuki R, Miyagi E, Takahashi N, Sukegawa A, Suzuki A, Koike I, et al. Validity of positron emission tomography using fluoro-2-deoxyglucose for the preoperative evaluation of endometrial cancer. Int J Gynecol Cancer 2007;17:890–6.

    Article  PubMed  CAS  Google Scholar 

  39. Lerman H, Metser U, Grisaru D, Fishman A, Lievshitz G, Even-Sapir E. Normal and abnormal 18F-FDG endometrial and ovarian uptake in pre- and postmenopausal patients: assessment by PET/CT. J Nucl Med 2004;45:266–71.

    PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by a grant of the Korea Health 21 R&D Project, Ministry of Health &Welfare, Republic of Korea (0412-CR01-0704-0001).

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, South Korea

    Hyun Hoon Chung, Jae Weon Kim, Noh-Hyun Park, Yong-Sang Song & Soon-Beom Kang

  2. Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, South Korea

    Won Jun Kang & June-Key Chung

Authors
  1. Hyun Hoon Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Won Jun Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jae Weon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Noh-Hyun Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yong-Sang Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. June-Key Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Soon-Beom Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Noh-Hyun Park.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chung, H.H., Kang, W.J., Kim, J.W. et al. The clinical impact of [18F]FDG PET/CT for the management of recurrent endometrial cancer: correlation with clinical and histological findings. Eur J Nucl Med Mol Imaging 35, 1081–1088 (2008). https://doi.org/10.1007/s00259-007-0687-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-007-0687-8

Keywords

Search

Navigation