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Additional value of 16α-[18F]fluoro-17β-oestradiol PET for differential diagnosis between uterine sarcoma and leiomyoma in patients with positive or equivocal findings on [18F]fluorodeoxyglucose PET

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Abstract

Purpose

Pathological data suggest that the rate of oestrogen receptor (ER) expression in uterine sarcoma is significantly lower than in leiomyoma. The present study aimed to investigate whether ER expression using ER imaging agents for positron emission tomography (PET), of which the most successful has been 16α-[18F]-fluoro-17β-oestradiol (FES), is able to add useful information to the differential diagnosis of uterine sarcoma and leiomyoma in patients with positive or equivocal findings on [18F]fluorodeoxyglucose (FDG) PET.

Methods

A total of 76 patients with suspected uterine sarcoma based on ultrasound and magnetic resonance imaging findings from 2007 to 2010 were enrolled. Twenty-four of the present patients were referred for FES PET because of FDG PET findings that showed equivocal or positive FDG uptake. PET images were quantitatively evaluated with reference to histopathological findings. Receiver-operating characteristic analysis was performed to determine the optimal cutoff value to differentiate uterine sarcoma and leiomyoma.

Results

Of the 24 patients, 11 had a final diagnosis of uterine sarcoma, while 13 had leiomyoma. The sensitivity, specificity and accuracy of an FDG to FES standardized uptake value (SUV) ratio greater than 2.0 were significantly higher using Cochran’s Q test (p = 0.024) when compared with FDG PET greater than 3.0 alone (90.9 vs 81.8%, 92.3 vs 84.6% and 91.3 vs 83.3%, respectively).

Conclusion

Additional FES PET findings confirmed uterine sarcoma in 91.3% of a selected group of patients with equivocal or positive FDG uptake.

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Acknowledgments

This study was partly funded by the Research and Development Project Aimed at Economic Revitalization (Leading Project) from MEXT Japan, Grants-in-Aid for Scientific Research (Nos. 20790887 and 21390342) and the 21st Century Center of Excellence Program from the Japan Society for the Promotion of Science.

Conflicts of interest

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Authors and Affiliations

  1. Department of Gynecology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan

    Yoshio Yoshida, Tetsuji Kurokawa & Fumikazu Kotsuji

  2. Biomedical Imaging Research Center, University of Fukui, Fukui, Japan

    Yasushi Kiyono, Tetsuya Tsujikawa & Hidehiko Okazawa

Authors
  1. Yoshio Yoshida
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  2. Yasushi Kiyono
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  3. Tetsuya Tsujikawa
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  4. Tetsuji Kurokawa
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  5. Hidehiko Okazawa
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  6. Fumikazu Kotsuji
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Correspondence to Yoshio Yoshida.

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Yoshida, Y., Kiyono, Y., Tsujikawa, T. et al. Additional value of 16α-[18F]fluoro-17β-oestradiol PET for differential diagnosis between uterine sarcoma and leiomyoma in patients with positive or equivocal findings on [18F]fluorodeoxyglucose PET. Eur J Nucl Med Mol Imaging 38, 1824–1831 (2011). https://doi.org/10.1007/s00259-011-1851-8

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  • DOI: https://doi.org/10.1007/s00259-011-1851-8

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