| Objective 1.To investigate application of 18F-FDG PET/CT in lymph node metastases.2.To investigate the correlations between metabolic parameters of primary lesion with clinicopathological features of patients with endometrial cancer.Materials and Methods A total of 45 postoperative pathology-proven endometrial cancer patients were enrolled into this retrospective study.All underwent 18F-FDG PET/CT before treatment.The lymph node metastasis of 18F-FDG PET/CT was compared with the postoperative pathology,and obtaine the efficiency of 18F-FDG PET/CT in lymph node metastasis.SUVmax,SUVmean and MTV were measured,and TLG was calculated.The relationship between metabolic parameters and the clinicapathological features were analyzed by the Mann–Whitney Results U test and the Jonckheera–Terpsta trend test.ROC curves for identification of deep myometrial invasion and risk stratification were generated,and metabolic parameters cutoffs for predicting deep myometrial invasion and intermediate or high risk stratification endometrial cancer were calculated.Result Mean age for the 45 patients was 60.9 y?median,62y;range,39–76 y?.Surgical FIGO 2009 staging criteria identified stage IA in 51.1%?23/45?,stage IB in22.2%?10/45?,Stage II 4.4%?2/45?,stage III in 17.8%?8/45?,and stage IV in2%?2/45?.Among the 38 patients with the endometrioid subtype,data for grade were available in 36 cases:22.2%?8/36?grade 1,58.3%?21/36?grade 2,and 19.4%?7/36?grade 3.Clear cell histology was reported in 8.8%?4/45?,serous histology in 6.6%?3/45?.There were 29 lymph node metastases after surgery,21 of which were transferred by PET/CT,and 8 metastatic lymph nodes were false-negative on PET/CT,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of 18F-FDG PET/CT for detection of lymph node metastases were72.4%,97.7%,61.8%,98.5%and 96.4%,respectively.The mean SUVmax,SUVmean,MTV and TLG of 45 patients were 7.74?5.42-37.48?,10.43?2.64-19.67?,11.99?1.22-45.91?,132.50?7.17-695.98?,respectively.There were no significant diffrerence in the metabolic parameters related to histologic subtype,presence of cervical stroma invasion and ovarian metastasis?P>0.05?.MTV and TLG were statistically significant diffrerence in histologic grade,presence of lymph node metastasis and diffrerences of risk stratification?P<0.05?.There were statistically significant diffrerences in the metabolic parameters related to depth of myometrial invasion.The AUCs for distinguishing the depth myometrial invasion were 0.754,0.718,0.851 and 0.891 of SUVmax,SUVmean,MTV and TLG,respectively.The AUC of TLG was larger than SUVmax,SUVmean and MTV.The cutoff point of SUVmax,SUVmean,MTV and TLG was 16.94,10.00,9.85 and 93.41,respectively.The sensitivity and specificity of the four metabolic parameters was 70.6%and64.3%,70.6%and 61.7%,76.5%and 78.6%,82.4%and 78.6%,respectively.The AUCs for distinguishing the diffrerences risk stratification were 0.640,0.614,0.853and 0.822 of SUVmax,SUVmean,MTV and TLG,respectively.The AUC of MTV was larger than SUVmax,SUVmean and TLG.The sensitivity and specificity of the four metabolic parameters was 79.2%and 47.4%,66.7%and 57.9%,75.0%and 78.9%,87.5%and 63.2%,respectively.Conclusion 1.Lymph node metastases in patients with endometrial cancer,particularly in specificity and negative predicted value,which can use for preoperative evaluation of endometrial cancer.2.Preoperative 18F-FDG PET/CT metabolic parameters can certainly reflect clinicopathological features of patients with endometrial cancer.For evaluation of depth of myometrial invasion,TLG is superior to SUVmax,SUVmean and MTV.MTV is an effective parameter for distinguishing risk stratification,which can prevent patients from unnecessary lymph node dissection. |
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