title: Metabolic Tumor Volume on 18F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients.
abstract: Our objective was to prospectively explore the diagnostic value of (18)F-FDG PET/CT for preoperative staging in endometrial carcinomas and to investigate whether (18)F-FDG PET-specific quantitative tumor parameters reflect clinical and histologic characteristics.
  
  
  METHODS
  Preoperative (18)F-FDG PET/CT was prospectively performed on 129 consecutive endometrial carcinoma patients. Two physicians who did not know the clinical findings or staging results independently reviewed the images, assessing primary tumor, cervical stroma involvement and metastatic spread, and determining maximum and mean standardized uptake value (SUVmax and SUVmean, respectively) for tumor, metabolic tumor volume (MTV), and total lesion glycolysis (TLG). All parameters were analyzed in relation to histomorphologic and clinical tumor characteristics. Receiver-operating-characteristic curves for identification of deep myometrial invasion and lymph node metastases were generated, and MTV cutoffs for predicting deep myometrial invasion and lymph node metastases were calculated.
  
  
  RESULTS
  The sensitivity, specificity, and accuracy of (18)F-FDG PET/CT for the detection of lymph node metastases were 77%-85%, 91%-96%, and 89%-93%, respectively. SUVmax, SUVmean, MTV, and TLG were significantly related to deep myometrial invasion, presence of lymph node metastases, and high histologic grade (P < 0.015 for all) and independently predicted deep myometrial invasion (P < 0.015) and lymph node metastases (P < 0.025) after adjustment for preoperative histologic risk (based on subtype and grade) in endometrial biopsies. Optimal cutoffs for MTV in predicting deep myometrial invasion (20 mL) and the presence of lymph node metastases (30 mL) yielded odds ratios of 7.8 (P < 0.001) and 16.5 (P = 0.001), respectively.
  
  
  CONCLUSIONS
  (18)F-FDG PET/CT represents a clinically valuable tool for preoperatively evaluating the presence of lymph node metastases in endometrial carcinoma patients. Applying MTV cutoffs for the prediction of deep myometrial invasion and lymph node metastases may increase diagnostic accuracy and aid preoperative identification of high-risk patients, enabling restriction of lymphadenectomy for patients with a low risk of aggressive disease.
authors.affiliation: Center for PET/NM and Department of Radiology, Haukeland University Hospital, Bergen, Norway Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway jenny.hild.aase@helse-bergen.no.
authors.forename: Jenny A
authors.initials: JA
authors.lastname: Husby
authors.affiliation: Center for PET/NM and Department of Radiology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Bernt C
authors.initials: BC
authors.lastname: Reitan
authors.affiliation: Center for PET/NM and Department of Radiology, Haukeland University Hospital, Bergen, Norway Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway.
authors.forename: Martin
authors.initials: M
authors.lastname: Biermann
authors.affiliation: Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway Norway Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway; and.
authors.forename: Jone
authors.initials: J
authors.lastname: Trovik
authors.affiliation: Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway Norway Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway; and.
authors.forename: Line
authors.initials: L
authors.lastname: Bjørge
authors.affiliation: Center for PET/NM and Department of Radiology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Inger J
authors.initials: IJ
authors.lastname: Magnussen
authors.affiliation: Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Øyvind O
authors.initials: ØO
authors.lastname: Salvesen
authors.affiliation: Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway Norway Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway; and.
authors.forename: Helga B
authors.initials: HB
authors.lastname: Salvesen
authors.affiliation: Center for PET/NM and Department of Radiology, Haukeland University Hospital, Bergen, Norway Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway.
authors.forename: Ingfrid S
authors.initials: IS
authors.lastname: Haldorsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor; D001706:Biopsy; D002277:Carcinoma / Q000000981:diagnostic imaging*; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006019:Glycolysis; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D009215:Myometrium / Q000473:pathology; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D012372:ROC Curve; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D047368:Tumor Burden
chemical_list: D014408:Biomarkers, Tumor; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: 18F-FDG PET/CT; cancer staging; endometrial carcinoma; incidental findings; metabolic tumor volume