18F-FDG PET in the management of endometrial cancer

Purpose: Few studies have investigated the clinical impact of whole-body positron emission tomography (PET) with F-18-fluorodeoxyglucose (FDG) in endometrial cancer. We aimed to assess the value of integrating FDG-PET into the management of endometrial cancer in comparison with conventional imaging alone. Methods: All patients with histologically confirmed primary advanced ( stage III/IV) or suspicious/documented recurrent endometrial cancer, with poor prognostic features ( serum CA-125 > 35 U/ml or unfavourable cell types), or surveillance after salvage therapy were eligible. Before FDG-PET scanning, each patient had received magnetic resonance imaging and/or computed tomography (MRI-CT). The receiver operating characteristic curve method with calculation of the area under the curve (AUC) was used to compare the diagnostic efficacy. Clinical impacts were determined on a scan basis. Results: Forty-nine eligible patients were accrued and 60 studies were performed ( 27 primary staging, 33 post-therapy surveillance or restaging on relapse). The clinical impact was positive in 29 (48.3%) of the 60 scans. Mean standardised uptake values (SUVs) of true-positive lesions were 13.2 ( range 5.7 - 37.4) for central pelvic lesions and 11.1 ( range 1.5 - 37.4) for metastases. The sensitivity of FDG-PETalone ( P< 0.0001) or FDG-PET plus MRI-CT ( P< 0.0001) was significantly higher than that of MRI-CT alone in overall lesion detection. FDG-PET plus MRI-CT was significantly superior to MRI-CT alone in overall lesion detection (AUC 0.949 vs 0.872; P= 0.004), detection of pelvic nodal/soft tissue metastases ( P= 0.048) and detection of extrapelvic metastases ( P= 0.010), while FDG-PET alone was only marginally superior by AUC ( P= 0.063). Conclusion: Whole-body FDG-PET coupled with MRI-CT facilitated optimal management of endometrial cancer in well-selected cases.