Abstract
Objective:To explore the correlation of the primary tumor’s maximum standardized uptake value (SUVmax) and minimum apparent diffusion coefficient (ADCmin) with clinicopathologic features, and to determine their predictive power in endometrial cancer (EC).Methods:A total of 45 patients who had undergone staging surgery after a preoperative evaluation with 18F-fluorodeoxyglucose (FDG) positron emission tomography/computerized tomography (PET/CT) and diffusion-weighted magnetic resonance imaging (DW-MRI) were included in a prospective case-series study with planned data collection. Multiple linear regression analysis was used to determine the correlations between the study variables.Results:The mean ADCmin and SUVmax values were determined as 0.72±0.22 and 16.54±8.73, respectively. A univariate analysis identified age, myometrial invasion (MI) and lymphovascular space involvement (LVSI) as the potential factors associated with ADCmin while it identified age, stage, tumor size, MI, LVSI and number of metastatic lymph nodes as the potential variables correlated to SUVmax. In multivariate analysis, on the other hand, MI was the only significant variable that correlated with ADCmin (p=0.007) and SUVmax (p=0.024). Deep MI was best predicted by an ADCmin cutoff value of ≤0.77 [93.7% sensitivity, 48.2% specificity, and 93.0% negative predictive value (NPV)] and SUVmax cutoff value of >20.5 (62.5% sensitivity, 86.2% specificity, and 81.0% NPV); however, the two diagnostic tests were not significantly different (p=0.266).Conclusion:Among clinicopathologic features, only MI was independently correlated with SUVmax and ADCmin. However, the routine use of 18F-FDG PET/CT or DW-MRI cannot be recommended at the moment due to less than ideal predictive performances of both parameters.
Highlights
Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries [1]
We aimed to investigate relationships of SUVmax and ADCmin of the primary tumor to clinicopathologic features, and to compare their predictive ability in patients with EC
Radiologic, pathologic and clinical data including age at surgery, ADCmin and SUVmax of the primary tumor, date and extent of the surgical procedure, number of lymph nodes (LNs) removed, stage of the disease, tumor histotype, tumor grade, tumor size, depth of myometrial invasion, lymphovascular space involvement (LVSI), cervical invasion, adnexal invasion, LN involvement, number of metastatic LNs, adjuvant therapy, disease status after primary therapy, disease recurrence, survival status, and the date of the last follow-up were recorded for all patients, following the The study were approved by the Akdeniz University of Local Ethics Committee (Protocol number: 23.12.2015; 386)
Summary
Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries [1]. The majority of patients present with disease limited to the uterus at the time of diagnosis, which leads to a generally high survival rate [2]. EC is staged surgically using the International Federation of Gynecology and Obstetrics (FIGO) and American Joint Committee on Cancer staging systems [4,5]. A systematic lymphadenectomy leads to a doubling of the complication rate [7]. There are two randomized controlled trials demonstrating no survival benefit for lymphadenectomy especially in patients with presumed uterine-confined disease [8,9]
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