Skip to main content
SpringerLink
Log in

Preoperative PET/CT standardized FDG uptake values of pelvic lymph nodes as a significant prognostic factor in patients with endometrial cancer

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

Abstract

Purpose

Using integrated PET/CT, we evaluated the prognostic relevance of preoperative pelvic lymph node (LN) 18F-FDG uptake in endometrioid endometrial cancer.

Methods

We retrospectively reviewed patients with pathologically proven endometrial cancer who underwent preoperative 18F-FDG PET/CT scans to evaluate the prognostic significance of PET/CT parameters and other clinicopathological variables. We used Cox proportional hazards regression to examine the relationship between recurrence and the maximum standardized uptake value (SUVmax) in pelvic LNs (SUVLN) on FDG PET/CT.

Results

Clinical data, treatment modalities and results were reviewed in 70 eligible patients. The median postsurgical follow-up was 29 months (range 6 to 95 months). Receiver-operating characteristic analysis identified the significant SUVLN cut-off value as 15. The SUVLN correlated with FIGO stage (P < 0.001), LN metastasis (P < 0.001), lymphovascular space invasion (P < 0.001), SUVtumour (P = 0.001), metastatic LN size (P = 0.004), primary tumour size (P = 0.012), tumour grade (P = 0.015) and depth of tumour invasion (P = 0.035). Regression analysis showed a statistically significant association between recurrence and SUVLN (P = 0.002). Recurrence differed significantly (P < 0.001) between patients with SUVLN >15 and those with SUVLN ≤15.

Conclusion

Preoperative pelvic LN FDG uptake exhibited a strong significant association with recurrence of endometrioid endometrial cancer.

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. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90. doi: 10.3322/caac.20107.

    Article  PubMed  Google Scholar 

  2. Rose PG. Endometrial carcinoma. N Engl J Med. 1996;335:640–9. doi:10.1056/NEJM199608293350907.

    Article  CAS  PubMed  Google Scholar 

  3. Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I. Endometrial cancer. Lancet. 2005;366:491–505. doi:10.1016/S0140-6736(05)67063-8.

    Article  PubMed  Google Scholar 

  4. Odagiri T, Watari H, Hosaka M, Mitamura T, Konno Y, Kato T, et al. Multivariate survival analysis of the patients with recurrent endometrial cancer. J Gynecol Oncol. 2011;22:3–8. doi:10.3802/jgo.2011.22.1.3.

  5. Suh DH, Kim JW, Kim K, Kim HJ, Lee KH. Major clinical research advances in gynecologic cancer in 2012. J Gynecol Oncol. 2013;24:66–82. doi:10.3802/jgo.2013.24.1.66.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Berman ML, Ballon SC, Lagasse LD, Watring WG. Prognosis and treatment of endometrial cancer. Am J Obstet Gynecol. 1980;136:679–88.

    CAS  PubMed  Google Scholar 

  7. Larson DM, Connor GP, Broste SK, Krawisz BR, Johnson KK. Prognostic significance of gross myometrial invasion with endometrial cancer. Obstet Gynecol. 1996;88:394–8. doi:10.1016/0029-7844(96)00161-5.

    Article  CAS  PubMed  Google Scholar 

  8. Boronow RC, Morrow CP, Creasman WT, Disaia PJ, Silverberg SG, Miller A, et al. Surgical staging in endometrial cancer: clinical-pathologic findings of a prospective study. Obstet Gynecol. 1984;63:825–32.

    CAS  PubMed  Google Scholar 

  9. Lewin SN, Herzog TJ, Barrena Medel NI, Deutsch I, Burke WM, Sun X, et al. Comparative performance of the 2009 international Federation of gynecology and obstetrics’ staging system for uterine corpus cancer. Obstet Gynecol. 2010;116:1141–9. doi:10.1097/AOG.0b013e3181f39849.

    Article  PubMed  Google Scholar 

  10. Amit A, Schink J, Reiss A, Lowenstein L. PET/CT in gynecologic cancer: present applications and future prospects—a clinician's perspective. Obstet Gynecol Clin North Am. 2011;38:1–21, vii. doi: 10.1016/j.ogc.2011.02.001.

  11. Westerterp M, Pruim J, Oyen W, Hoekstra O, Paans A, Visser E, et al. Quantification of FDG PET studies using standardised uptake values in multi-centre trials: effects of image reconstruction, resolution and ROI definition parameters. Eur J Nucl Med Mol Imaging. 2007;34:392–404. doi:10.1007/s00259-006-0224-1.

    Article  PubMed  Google Scholar 

  12. 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. doi:10.1006/gyno.2002.6606.

    Article  CAS  PubMed  Google Scholar 

  13. 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. doi:10.1006/gyno.1993.1272.

    Article  CAS  PubMed  Google Scholar 

  14. Kitajima K, Kita M, Suzuki K, Senda M, Nakamoto Y, Sugimura K. Prognostic significance of SUVmax (maximum standardized uptake value) measured by [18F]FDG PET/CT in endometrial cancer. Eur J Nucl Med Mol Imaging. 2012;39:840–5. doi:10.1007/s00259-011-2057-9.

    Article  PubMed  Google Scholar 

  15. Lee HJ, Ahn BC, Hong CM, Song BI, Kim HW, Kang S, et al. Preoperative risk stratification using (18)F-FDG PET/CT in women with endometrial cancer. Nuklearmedizin. 2011;50:204–13. doi: 10.3413/nukmed-0375-10-12.

    Article  CAS  PubMed  Google Scholar 

  16. Nakamura K, Hongo A, Kodama J, Hiramatsu Y. The measurement of SUVmax of the primary tumor is predictive of prognosis for patients with endometrial cancer. Gynecol Oncol. 2011;123:82–7. doi: 10.1016/j.ygyno.2011.06.026.

    Article  PubMed  Google Scholar 

  17. Nakamura K, Kodama J, Okumura Y, Hongo A, Kanazawa S, Hiramatsu Y. The SUVmax of 18F-FDG PET correlates with histological grade in endometrial cancer. Int J Gynecol Cancer. 2010;20:110–5. doi:10.1111/IGC.0b013e3181c3a288.

    Article  PubMed  Google Scholar 

  18. Torizuka T, Nakamura F, Takekuma M, Kanno T, Ogusu T, Yoshikawa E, et al. FDG PET for the assessment of myometrial infiltration in clinical stage I uterine corpus cancer. Nucl Med Commun. 2006;27:481–7.

    Article  PubMed  Google Scholar 

  19. Chung HH, Kim JW, Kang KW, Park NH, Song YS, Chung JK, et al. Post-treatment [18F]FDG maximum standardized uptake value as a prognostic marker of recurrence in endometrial carcinoma. Eur J Nucl Med Mol Imaging. 2011;38:74–80. doi:10.1007/s00259-010-1614-y.

    Article  PubMed  Google Scholar 

  20. Kidd EA, Siegel BA, Dehdashti F, Grigsby PW. Pelvic lymph node F-18 fluorodeoxyglucose uptake as a prognostic biomarker in newly diagnosed patients with locally advanced cervical cancer. Cancer. 2010;116:1469–75. doi:10.1002/cncr.24972.

    Article  PubMed  Google Scholar 

  21. Chung HH, Cheon GJ, Kang KW, Kim JW, Park NH, Song YS. Preoperative PET/CT FDG standardized uptake value of pelvic lymph nodes as a significant prognostic factor in patients with uterine cervical cancer. Eur J Nucl Med Mol Imaging. 2014;41:674–81. doi:10.1007/s00259-013-2626-1.

    Article  PubMed  Google Scholar 

  22. Kitajima K, Murakami K, Yamasaki E, Fukasawa I, Inaba N, Kaji Y, et al. Accuracy of 18F-FDG PET/CT in detecting pelvic and paraaortic lymph node metastasis in patients with endometrial cancer. AJR Am J Roentgenol. 2008;190:1652–8. doi:10.2214/AJR.07.3372.

    Article  PubMed  Google Scholar 

  23. Park JY, Kim EN, Kim DY, Suh DS, Kim JH, Kim YM, et al. Comparison of the validity of magnetic resonance imaging and positron emission tomography/computed tomography in the preoperative evaluation of patients with uterine corpus cancer. Gynecol Oncol. 2008;108:486–92. doi:10.1016/j.ygyno.2007.11.044.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by grant no 3420130200 (2013-0362) from the SK Telecom Research Fund, Seoul National University Hospital.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea

    Hyun Hoon Chung, Hee Seung Kim, Jae Weon Kim, Noh-Hyun Park & Yong Sang Song

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

    Gi Jeong Cheon

  3. WCU Biomodulation Major, Department of Agricultural Biotechnology, College of Agriculture and Life Sciences, Seoul National University, Seoul, Republic of Korea

    Yong Sang Song

Authors
  1. Hyun Hoon Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gi Jeong Cheon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hee Seung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jae Weon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Noh-Hyun Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yong Sang Song
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hyun Hoon Chung.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chung, H.H., Cheon, G.J., Kim, H.S. et al. Preoperative PET/CT standardized FDG uptake values of pelvic lymph nodes as a significant prognostic factor in patients with endometrial cancer. Eur J Nucl Med Mol Imaging 41, 1793–1799 (2014). https://doi.org/10.1007/s00259-014-2775-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-014-2775-x

Keywords

Search

Navigation