Clinical and prognostic value of 18F-FDG PET/CT in recurrent endometrial carcinoma

Abstract

PurposeEndometrial carcinoma (EC) is a cancer with a good overall prognosis, except in cases of recurrent or advanced EC. The aim of this study was to assess the diagnostic performance, the prognostic value and the impact on therapeutic management of 18F-FDG-PET/CT in suspected recurrent EC. Materials and methodsWe retrospectively evaluated 157 patients with histologically proven EC and restaging 18F-FDG-PET/CT for suspected recurrence. The PET images were analyzed visually and semi-quantitatively by measuring SUVmax, MTV and TLG. A combination of clinical/imaging follow-up and/or histopathology was taken as reference standard. PFS and OS were computed using Kaplan–Meier curves. ResultsSeventy-nine patients had positive 18F-FDG-PET/CT showing the presence of at least one hypermetabolic lesion consistent with recurrence, while the remaining 78 were negative. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 18F-FDG-PET/CT were 96%, 99%, 99%, 96%, 97% respectively and were higher compared to conventional imaging: 97%, 62%, 72%, 96%, 80%. After a mean follow-up of 39 months, relapse/progression occurred in 58 patients and death in 37 with an average time of 22.1 and 27.6 months respectively. A positive 18F-FDG-PET/CT and advanced FIGO stage were significantly associated with shorter PFS and OS. PET/CT results had a significant impact on therapeutic approach in 33 patients: avoiding unnecessary therapies in 28 and modifying therapy in 5. Conclusions18F-FDG-PET/CT has a very good diagnostic performance in patients with suspected recurrent EC and has an important prognostic value in assessing PFS and OS. Moreover, PET/CT allowed for a change in treatment decision in about 20% of cases.