title: Preoperative risk stratification using metabolic parameters of (18)F-FDG PET/CT in patients with endometrial cancer.
abstract: OBJECTIVE
  To evaluate the usefulness of metabolic parameters obtained by (18)F-FDG PET/CT for preoperative stratification of high-risk and low-risk endometrial carcinomas.
  
  
  METHODS
  Preoperative (18)F-FDG PET/CT was performed in 56 women with endometrial cancer. Maximum standardized uptake values (SUVmax), metabolic tumour volume (MTV) and total lesion glycolysis (TLG) of primary tumours were compared with clinicopathological features of surgical specimens. Diagnostic performance in terms of differentiation of low-risk disease (endometrioid histology, histological grade 1 or 2, invasion of less than half of the myometrium, and FIGO stage I) from high-risk disease was assessed.
  
  
  RESULTS
  MTV and TLG were significantly higher in patients with higher histological grade (p = 0.0026 and p = 0.034), larger tumour size (p = 0.002 and p = 0.0017), lymphovascular space involvement (LVSI; p = 0.012 and p = 0.0051), myometrial invasion (p = 0.027 and p = 0.031), cervical stromal invasion (p = 0.023 and p = 0.014), ovarian metastasis (p = 0.00022 and p = 0.00034), lymph node metastasis (p < 0.0001 and p < 0.0001), and higher FIGO stage (p = 0.0011 and p = 0.00048). SUVmax was significantly higher in patients with larger tumour size (p = 0.0025), LVSI (p = 0.00023) and myometrial invasion (p < 0.0001). The areas under the ROC curves (AUCs) for distinguishing high-risk from low-risk carcinoma were 0.625, 0.829 and 0.797 for SUVmax, MTV and TLG, respectively. AUCs for both MTV and TLG were significantly larger than that for SUVmax (p = 0.0049 and p = 0.021). The optimal TLG cut-off value of 70.2, determined by ROC analysis, was found to have 72.0% sensitivity and 74.2% specificity for risk stratification.
  
  
  CONCLUSIONS
  MTV and TLG of primary endometrial cancer show better correlations with clinicopathological features and are more useful for differentiating high-risk from low-risk carcinoma than SUVmax.
authors.affiliation: Department of Radiology, Kobe University School of Medicine, Kobe, Japan, kitajima@med.kobe-u.ac.jp.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kitajima
authors.forename: Yuko
authors.initials: Y
authors.lastname: Suenaga
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Ueno
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Maeda
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Ebina
authors.forename: Hideto
authors.initials: H
authors.lastname: Yamada
authors.forename: Takashi
authors.initials: T
authors.lastname: Okunaga
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kubo
authors.forename: Keitarou
authors.initials: K
authors.lastname: Sofue
authors.forename: Tomonori
authors.initials: T
authors.lastname: Kanda
authors.forename: Yukihisa
authors.initials: Y
authors.lastname: Tamaki
authors.forename: Kazuro
authors.initials: K
authors.lastname: Sugimura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000000981:diagnostic imaging*; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
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