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18F-FLT PET performs better than 18F-FDG PET in differentiating malignant uterine corpus tumors from benign leiomyoma

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Abstract

Purpose

The aim of this study is to test the hypothesis that positron emission tomography (PET) with 3′-deoxy-3′-[18F]-fluorothymidine (18F-FLT) can differentiate malignancy from benign leiomyoma better than PET with 2-deoxy-2-[18F]fluoro-d-glucose (18F-FDG), and to evaluate whether 18F-FLT and 18F-FDG uptake correlate with immunohistochemical index of cell proliferation.

Methods

The protocol of this prospective study was approved by the institutional ethics committee, and all patients gave written informed consent. Fifteen patients (aged 26–65 years, median 44 years) with uterine corpus tumor which has the possibility of being leiomyosarcoma underwent 18F-FLT and 18F-FDG PET scans. Maximum standard uptake value (SUVmax) of PET scans and Ki-67 labeling index of surgical specimens were evaluated. Mann–Whitney’s U test was used for comparing uptakes between benign and malignant, and linear regression analysis was used for evaluating the correlation between Ki-67 labeling index and SUVmax.

Results

Five cases were diagnosed as malignant (leiomyosarcoma for 3 cases, and carcinoma for 2 cases), and the others were benign leiomyoma. Sensitivity and negative predictive value of both tracers for detecting malignancy was 100 %. Specificity, positive predictive value and accuracy of 18F-FLT PET were higher than those of 18F-FDG PET. Difference in SUVmax between malignant and benign was significant for 18F-FLT PET (P < 0.01), but not for 18F-FDG PET. While all the malignant cases showed positive uptake in both tracers, a case of leiomyosarcoma with huge necrosis showed relatively low uptake. Uptake of 18F-FLT showed better correlation with Ki-67 labeling index compared with 18F-FDG (R 2 = 0.91 vs. R 2 = 0.26).

Conclusion

Negative findings on additional 18F-FDG or 18F-FLT PET may rule out the possibility of malignancy for the patients with suspected leiomyosarcoma diagnosed by conventional methods. 18F-FLT PET is superior to 18F-FDG PET in differentiating malignant from benign leiomyoma. Moreover, 18F-FLT uptake correlated well with the immunohistochemical index of cell proliferation.

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References

  1. Sahdev A, Sohaib SA, Jacobs I, Shepherd JH, Oram DH, Reznek RH. MR imaging of uterine sarcomas. AJR Am J Roentgenol. 2001;177:1307–11.

    PubMed  CAS  Google Scholar 

  2. Grgic A, Yuksel Y, Groschel A, Schafers HJ, Sybrecht GW, Kirsch CM, et al. Risk stratification of solitary pulmonary nodules by means of PET using 18F-fluorodeoxyglucose and SUV quantification. Eur J Nucl Med Mol Imaging. 2010;37:1087–94.

    Article  PubMed  Google Scholar 

  3. Boland GW, Dwamena BA, Jagtiani Sangwaiya M, Goehler AG, Blake MA, Hahn PF, et al. Characterization of adrenal masses by using FDG PET: a systematic review and meta-analysis of diagnostic test performance. Radiology 2011;259:117–126.

    Google Scholar 

  4. Ozaki Y, Oguchi K, Hamano H, Arakura N, Muraki T, Kiyosawa K, et al. Differentiation of autoimmune pancreatitis from suspected pancreatic cancer by fluorine-18 fluorodeoxyglucose positron emission tomography. J Gastroenterol. 2008;43:144–51.

    Article  PubMed  CAS  Google Scholar 

  5. Kitajima K, Murakami K, Yamasaki E, Kaji Y, Sugimura K. Standardized uptake values of uterine leiomyoma with 18F-FDG PET/CT: variation with age, size, degeneration, and contrast enhancement on MRI. Ann Nucl Med. 2008;22:505–12.

    Article  PubMed  Google Scholar 

  6. Tavassoli FA, Devilee P. Pathology and genetics of tumours of the breast and female genital organs (Who/IARC Classification of Tumours). Lyon: IARC Press; 2003.

    Google Scholar 

  7. Gokaslan H, Turkeri L, Kavak ZN, Eren F, Sismanoglu A, Ilvan S, et al. Differential diagnosis of smooth muscle tumors utilizing p53, pTEN and Ki-67 expression with estrogen and progesterone receptors. Gynecol Obstet Invest. 2005;59:36–40.

    Article  PubMed  Google Scholar 

  8. O’Neill CJ, McBride HA, Connolly LE, McCluggage WG. Uterine leiomyosarcomas are characterized by high p16, p53 and MIB1 expression in comparison with usual leiomyomas, leiomyoma variants and smooth muscle tumours of uncertain malignant potential. Histopathology. 2007;50:851–8.

    Article  PubMed  Google Scholar 

  9. Buck AK, Halter G, Schirrmeister H, Kotzerke J, Wurziger I, Glatting G, et al. Imaging proliferation in lung tumors with PET: 18F-FLT versus 18F-FDG. J Nucl Med. 2003;44:1426–31.

    PubMed  CAS  Google Scholar 

  10. Buck AK, Bommer M, Stilgenbauer S, Juweid M, Glatting G, Schirrmeister H, et al. Molecular imaging of proliferation in malignant lymphoma. Cancer Res. 2006;66:11055–61.

    Article  PubMed  CAS  Google Scholar 

  11. Hatakeyama T, Kawai N, Nishiyama Y, Yamamoto Y, Sasakawa Y, Ichikawa T, et al. 11C-methionine (MET) and 18F-fluorothymidine (FLT) PET in patients with newly diagnosed glioma. Eur J Nucl Med Mol Imaging. 2008;35:2009–17.

    Article  PubMed  CAS  Google Scholar 

  12. Bradley LD. Uterine fibroid embolization: a viable alternative to hysterectomy. Am J Obstet Gynecol. 2009;201:127–35.

    Article  PubMed  Google Scholar 

  13. Stovall DW. Alternatives to hysterectomy: focus on global endometrial ablation, uterine fibroid embolization, and magnetic resonance-guided focused ultrasound. Menopause. 2011;18:437–44.

    Article  PubMed  Google Scholar 

  14. Goldberg J, Burd I, Price FV, Worthington-Kirsch R. Leiomyosarcoma in a premenopausal patient after uterine artery embolization. Am J Obstet Gynecol. 2004;191:1733–5.

    Article  PubMed  Google Scholar 

  15. Iihara K, Hirano K, Fujioka Y, Sakamoto A. Leiomyosarcoma with dedifferentiation in a premenopausal patient discovered after uterine artery embolization. Pathol Int. 2007;57:681–7.

    Article  PubMed  Google Scholar 

  16. Nishizawa S, Inubushi M, Kido A, Miyagawa M, Inoue T, Shinohara K, et al. Incidence and characteristics of uterine leiomyomas with FDG uptake. Ann Nucl Med. 2008;22:803–10.

    Article  PubMed  Google Scholar 

  17. Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med. 2009;50(Suppl 1):122S–50S.

    Article  PubMed  CAS  Google Scholar 

  18. Ho KC, Lai CH, Wu TI, Ng KK, Yen TC, Lin G, et al. 18F-fluorodeoxyglucose positron emission tomography in uterine carcinosarcoma. Eur J Nucl Med Mol Imaging. 2008;35:484–92.

    Article  PubMed  Google Scholar 

  19. Tsujikawa T, Yoshida Y, Mori T, Kurokawa T, Fujibayashi Y, Kotsuji F, et al. Uterine tumors: pathophysiologic imaging with 16alpha-[18F]fluoro-17beta-estradiol and 18F fluorodeoxyglucose PET—initial experience. Radiology. 2008;248:599–605.

    Article  PubMed  Google Scholar 

  20. Yoshida Y, Kiyono Y, Tsujikawa T, Kurokawa T, Okazawa H, Kotsuji F. Additional value of 16alpha-[18F]fluoro-17beta-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. 2011;38:1824–31.

    Article  PubMed  CAS  Google Scholar 

  21. Akhan SE, Yavuz E, Tecer A, Iyibozkurt CA, Topuz S, Tuzlali S, et al. The expression of Ki-67, p53, estrogen and progesterone receptors affecting survival in uterine leiomyosarcomas. A clinicopathologic study. Gynecol Oncol. 2005;99:36–42.

    Article  PubMed  CAS  Google Scholar 

  22. D’Angelo E, Espinosa I, Ali R, Gilks CB, Rijn M, Lee CH, et al. Uterine leiomyosarcomas: tumor size, mitotic index, and biomarkers Ki67, and Bcl-2 identify two groups with different prognosis. Gynecol Oncol. 2011;121:328–33.

    Article  PubMed  Google Scholar 

  23. Sreenan JJ, Prayson RA, Biscotti CV, Thornton MH, Easley KA, Hart WR. Histopathologic findings in 107 uterine leiomyomas treated with leuprolide acetate compared with 126 controls. Am J Surg Pathol. 1996;20:427–32.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This study was partly supported by Grant-in-Aid for Young Scientists (B), KAKENHI (22791241).

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Authors and Affiliations

  1. Division of Molecular Imaging, Institute of Biomedical Research and Innovation, 2-2, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan

    Tomohiko Yamane & Michio Senda

  2. Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan

    Aki Takaoka & Masato Kita

  3. Department of Clinical Pathology, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan

    Yukihiro Imai

Authors
  1. Tomohiko Yamane
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  2. Aki Takaoka
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  3. Masato Kita
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  4. Yukihiro Imai
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  5. Michio Senda
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Corresponding author

Correspondence to Tomohiko Yamane.

Additional information

Registration identification number for the trial’s registry: UMIN-CTR: UMIN000003338 (www.umin.ac.jp/ctr/index/htm).

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Yamane, T., Takaoka, A., Kita, M. et al. 18F-FLT PET performs better than 18F-FDG PET in differentiating malignant uterine corpus tumors from benign leiomyoma. Ann Nucl Med 26, 478–484 (2012). https://doi.org/10.1007/s12149-012-0597-0

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  • DOI: https://doi.org/10.1007/s12149-012-0597-0

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