Abstract
PurposeWe aim to compare the radiomic features and parameters on 2-deoxy-2-[fluorine-18] fluoro-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) between patients with endometrial cancer with Lynch syndrome and those with endometrial cancer without Lynch syndrome. We also hope to explore the biologic significance of selected radiomic features.Materials and MethodsWe conducted a retrospective cohort study, first using the 18F-FDG PET/CT images and clinical data from 100 patients with endometrial cancer to construct a training group (70 patients) and a test group (30 patients). The metabolic parameters and radiomic features of each tumor were compared between patients with and without Lynch syndrome. An independent cohort of 23 patients with solid tumors was used to evaluate the value of selected radiomic features in predicting the expression of the programmed cell death 1 (PD1), using 18F-FDG PET/CT images and RNA-seq genomic data.ResultsThere was no statistically significant difference in the standardized uptake values on PET between patients with endometrial cancer with Lynch syndrome and those with endometrial cancer without Lynch syndrome. However, there were significant differences between the 2 groups in metabolic tumor volume and total lesion glycolysis (p < 0.005). There was a difference in the radiomic feature of gray level co-occurrence matrix entropy (GLCMEntropy; p < 0.001) between the groups: the area under the curve was 0.94 in the training group (sensitivity, 82.86%; specificity, 97.14%) and 0.893 in the test group (sensitivity, 80%; specificity, 93.33%). In the independent cohort of 23 patients, differences in GLCMEntropy were related to the expression of PD1 (rs =0.577; p < 0.001).ConclusionsIn patients with endometrial cancer, higher metabolic tumor volumes, total lesion glycolysis values, and GLCMEntropy values on 18F-FDG PET/CT could suggest a higher risk for Lynch syndrome. The radiomic feature of GLCMEntropy for tumors is a potential predictor of PD1 expression.
Highlights
Endometrial cancer ranks sixth in global incidence for malignant tumors, with nearly 400 000 new cases diagnosed each year [1]
We established a probability formula [1], using radiomic features, for predicting the presence of Lynch syndrome in patients with endometrial cancer: Here, P(y) is the probability of Lynch syndrome in patients with endometrial carcinoma, and X is the value of GLCMEntropy in the lesion area on dimensionless positron emission tomography (PET) imaging
The Receiver operating characteristic (ROC) curve for patients with endometrial cancer with or without Lynch syndrome measured by radiomic features demonstrated the resolution of different PET parameters in the training group (Figure 2) and the test group (Figure 3)
Summary
Endometrial cancer ranks sixth in global incidence for malignant tumors, with nearly 400 000 new cases diagnosed each year [1]. First discovered in 1895, Lynch syndrome is known to be closely related to colorectal cancer and endometrial cancer, and accounts for 2% to 6% of the latter [4, 5]. Lynch syndrome creates pathology through a mutation in the mismatch repair gene (MMR) [6], and women with Lynch syndrome have a 25% to 60% likelihood of developing endometrial cancer in their lifetime [7]. In patients with Lynch’s syndrome, there are differences in treatment methods, immune infiltration and PD1 expression [8,9,10], survival rate [11, 12] and risk in other cancers, especially colon cancer [13]
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