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Cervical cancer evaluated with integrated 18F‑FDG PET/MR

  • Authors:
    • Jing Gong
    • Nan Wang
    • Lihua Bian
    • Min Wang
    • Mingxia Ye
    • Na Wen
    • Meng Fu
    • Wensheng Fan
    • Yuanguang Meng
  • View Affiliations / Copyright

    Affiliations: Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing 100853, P.R. China, Department of Obstetrics and Gynecology, Haidian Maternal and Child Health Hospital, Beijing 100080, P.R. China
    Copyright: © Gong et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Pages: 1815-1823
    |
    Published online on: June 21, 2019
       https://doi.org/10.3892/ol.2019.10514
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Abstract

The current study aimed to evaluate the correlation between maximum standardized uptake value (SUVmax) and minimum apparent diffusion coefficient (ADCmin) of cervical cancer using an integrated 18F‑fluorodeoxyglucose positron emission tomography/magnetic resonance (PET/MR) imaging system, and to determine the association with pathological prognostic factors. A total of 46 patients were pathologically diagnosed with cervical cancer and underwent PET/MR prior to surgery, including total hysterectomy, bilateral pelvic lymph node dissection or paraaortic lymph node dissection. The imaging biomarkers included the SUVmax and ADCmin. The pathological prognostic factors were as follows: Tumor size, histological grade, International Federation of Gynecology and Obstetrics (FIGO) stage and lymph node metastasis. Pearson's correlation analysis was used to evaluate the correlation between imaging biomarkers and the tumor size and the Mann‑Whitney U test analysis was used to evaluate the association between imaging biomarkers and pathological factors. The mean SUVmax was 11.1±8.7 (range, 3.16‑51.6) and the mean ADCmin was 0.76±0.15x10‑3 mm2/s (range, 0.47‑1.04x10‑3 mm2/s). The SUVmax had a significant negative correlation with the ADCmin (r=‑0.700; P<0.001). The SUVmax was significantly increased in patients with poorly differentiated tumors (P=0.001), patients with FIGO stage IIB (P=0.005) and the patients with lymph node metastasis (P=0.040). The ADCmin was significantly decreased in patients with poorly differentiated tumors (P<0.001) and patients with FIGO stage IIB (P=0.017). Statistical analysis revealed no significant correlation between the tumor size and the SUVmax (r=0.286;P=0.054), or between the tumor size and the ADCmin (r=‑0.231; P=0.122). Area under the curve (AUC) analysis revealed that SUVmax had a higher diagnostic value for lymph node metastasis (AUC=0.681) and FIGO staging (AUC=0.837) compared with ADCmin, whereas ADCmin had a higher diagnostic value for the grade of pathological differentiation (AUC=0.816) compared with SUVmax (AUC=0.788). The results of the current study demonstrated that there was a significant negative correlation between SUVmax and ADCmin, which were associated with prognostic factors.
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1 

Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, Jemal A, Yu XQ and He J: Cancer statistics in China, 2015. CA Cancer J Clin. 66:115–132. 2016. View Article : Google Scholar : PubMed/NCBI

2 

Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J and Jemal A: Global cancer statistics, 2012. CA Cancer J Clin. 65:87–108. 2015. View Article : Google Scholar : PubMed/NCBI

3 

Petry KU: HPV and cervical cancer. In: HPV and cervical cancer. Springer; Berlin, Germany: pp. 59–62. 2012

4 

Bhatla N, Aoki D, Sharma DN and Sankaranarayanan R: Cancer of the cervix uteri. Int J Gynaecol Obstet. 2 (Suppl 143):S22–S36. 2018. View Article : Google Scholar

5 

Khiewvan B, Torigian DA, Emamzadehfard S, Paydary K, Salavati A, Houshmand S, Shamchi SP, Werner TJ, Aydin A, Roy SG, et al: Update of the role of PET/CT and PET/MRI in the management of patients with cervical cancer. Hell J Nucl Med. 19:254–268. 2016.PubMed/NCBI

6 

Tangjitgamol S, Anderson BO, See HT, Lertbutsayanukul C, Sirisabya N, Manchana T, Ilancheran A, Lee KM, Lim SE, Chia YN, et al: Management of endometrial cancer in Asia: Consensus statement from the asian oncology summit 2009. Lancet Oncol. 10:1119–1127. 2009. View Article : Google Scholar : PubMed/NCBI

7 

Huellner MW, Appenzeller P, Kuhn FP, Husmann L, Pietsch CM, Burger IA, Porto M, Delso G, von Schulthess GK and Veit-Haibach P: Whole-body nonenhanced PET/MR versus PET/CT in the staging and restaging of cancers: Preliminary observations. Radiology. 273:859–869. 2014. View Article : Google Scholar : PubMed/NCBI

8 

Preda L, Conte G, Bonello L, Giannitto C, Travaini LL, Raimondi S, Summers PE, Mohssen A, Alterio D, Cossu Rocca M, et al: Combining standardized uptake value of FDG-PET and apparent diffusion coefficient of DW-MRI improves risk stratification in head and neck squamous cell carcinoma. Eur Radiol. 26:4432–4441. 2016. View Article : Google Scholar : PubMed/NCBI

9 

Viswanathan C, Faria S, Devine C, Patnana M, Sagebiel T, Iyer RB and Bhosale PR: [18F]-2-Fluoro-2-Deoxy-D-glucose-PET assessment of cervical cancer. PET Clin. 13:165–177. 2018. View Article : Google Scholar : PubMed/NCBI

10 

Grant P, Sakellis C and Jacene HA: Gynecologic Oncologic Imaging With PET/CT. Semin Nucl Med. 44:461–478. 2014. View Article : Google Scholar : PubMed/NCBI

11 

Nakamura K, Joja I, Fukushima C, Haruma T, Hayashi C, Kusumoto T, Seki N, Hongo A and Hiramatsu Y: The preoperative SUVmax is superior to ADCmin of the primary tumour as a predictor of disease recurrence and survival in patients with endometrial cancer. Eur J Nucl Med Mol Imaging. 40:52–60. 2013. View Article : Google Scholar : PubMed/NCBI

12 

Collins CD: PET/CT in oncology: For which tumours is it the reference standard? Cancer Imaging 7 Spec No A. S77–S87. 2007. View Article : Google Scholar

13 

Ashwin KR and Somashekhar SP: Management of early stage cervical cancer. Rev Recent Clin Trials. 10:302–308. 2015. View Article : Google Scholar : PubMed/NCBI

14 

Kjær A, Loft A, Law I, Berthelsen AK, Borgwardt L, Löfgren J, Johnbeck CB, Hansen AE, Keller S, Holm S and Højgaard L: PET/MRI in cancer patients: First experiences and vision from copenhagen. MAGMA. 26:37–47. 2013. View Article : Google Scholar : PubMed/NCBI

15 

Platzek I, Beuthien-Baumann B, Langner J, Popp M, Schramm G, Ordemann R, Laniado M, Kotzerke J and van den Hoff J: PET/MR for therapy response evaluation in malignant lymphoma: Initial experience. MAGMA. 26:49–55. 2013. View Article : Google Scholar : PubMed/NCBI

16 

Drzezga A, Souvatzoglou M, Eiber M, Beer AJ, Fürst S, Martinez-Möller A, Nekolla SG, Ziegler S, Ganter C, Rummeny EJ and Schwaiger M: First clinical experience with integrated whole-body PET/MR: Comparison to PET/CT in patients with oncologic diagnoses. J Nucl Med. 53:845–855. 2012. View Article : Google Scholar : PubMed/NCBI

17 

Er HÇ, Erden A, Küçük NÖ and Geçim E: Correlation of minimum apparent diffusion coefficient with maximum standardized uptake on fluorodeoxyglucose PET-CT in patients with rectal adenocarcinoma. Diagn Interv Radiol. 20:105–109. 2014.PubMed/NCBI

18 

Grueneisen J, Beiderwellen K, Heusch P, Buderath P, Aktas B, Gratz M, Forsting M, Lauenstein T, Ruhlmann V and Umutlu L: Correlation of standardized uptake value and apparent diffusion coefficient in integrated whole-body PET/MRI of primary and recurrent cervical cancer. PLoS One. 9:e967512014. View Article : Google Scholar : PubMed/NCBI

19 

Baba S, Isoda T, Maruoka Y, Kitamura Y, Sasaki M, Yoshida T and Honda H: Diagnostic and prognostic value of pretreatment SUV in 18F-FDG/PET in breast cancer: Comparison with apparent diffusion coefficient from diffusion-weighted MR imaging. J Nucl Med. 55:736–742. 2014. View Article : Google Scholar : PubMed/NCBI

20 

Kurman RJ, Carcangiu ML, Herrington CS and Young RH: WHO classification of tumours of female reproductive organs. 4th. IARC; Lyon: 2014

21 

Stock RJ, Zaino R, Bundy BN, Askin FB, Woodward J, Fetter B, Paulson JA, DiSaia PJ and Stehman FB: Evaluation and comparison of histopathologic grading systems of epithelial carcinoma of the uterine cervix: Gynecologic Oncology Group studies. Int J Gynecol Pathol. 13:99–108. 1994. View Article : Google Scholar : PubMed/NCBI

22 

Martinez-Möller A, Eiber M, Nekolla SG, Souvatzoglou M, Drzezga A, Ziegler S, Rummeny EJ, Schwaiger M and Beer AJ: Workflow and scan protocol considerations for integrated whole-body PET/MRI in oncology. J Nucl Med. 53:1415–1426. 2012. View Article : Google Scholar : PubMed/NCBI

23 

Shih IL, Yen RF, Chen CA, Chen BB, Wei SY, Chang WC, Sheu BC, Cheng WF, Tseng YH, Chen XJ, et al: Standardized uptake value and apparent diffusion coefficient of endometrial cancer evaluated with integrated whole-body PET/MR: Correlation with pathological prognostic factors. J Magn Reson Imaging. 42:1723–1732. 2015. View Article : Google Scholar : PubMed/NCBI

24 

Chung HH, Nam BH, Kim JW, Kang KW, Park NH, Song YS, Chung JK and Kang SB: Preoperative [18F]FDG PET/CT maximum standardized uptake value predicts recurrence of uterine cervical cancer. Eur J Nucl Med Mol Imaging. 37:1467–1473. 2010. View Article : Google Scholar : PubMed/NCBI

25 

Hayano K, Miura F, Amano H, Toyota N, Wada K, Kato K, Sano K, Takeshita K, Aoyagi T, Shuto K, et al: Correlation of apparent diffusion coefficientmeasured by diffusionweighted MRI and clinicopathologic features in pancreatic cancer patients. J Hepatobiliary Pancreat Sci. 20:243–248. 2013. View Article : Google Scholar : PubMed/NCBI

26 

Small W Jr, Strauss JB, Jhingran A, Yashar CM, Cardenes HR, Erickson-Wittmann BA, Gullett N, Kidd E, Lee LJ, Mayr NA, et al: ACR Appropriateness Criteria® definitive therapy for early-stage cervical cancer. Am J Clin Oncol. 35:399–405. 2012. View Article : Google Scholar : PubMed/NCBI

27 

Kidd EA, Spencer CR, Huettner PC, Siegel BA, Dehdashti F, Rader JS and Grigsby PW: Cervical cancer histology and tumor differentiation affect 18F-fluorodeoxyglucose uptake. Cancer. 115:3548–3554. 2009. View Article : Google Scholar : PubMed/NCBI

28 

Singh N and Arif S: Histopathologic parameters of prognosis in cervical cancer-a review. Int J Gynecol Cancer. 14:741–750. 2004. View Article : Google Scholar : PubMed/NCBI

29 

Razek AA and Nada N: Correlation of choline/creatine and apparent diffusion coefficient values with the prognostic parameters of head and neck squamous cell carcinoma. NMR Biomed. 29:483–489. 2016. View Article : Google Scholar : PubMed/NCBI

30 

Jung NY, Kim SH, Kang BJ, Park SY and Chung MH: The value of primary tumor (18)F-FDG uptake on preoperative PET/CT for predicting intratumoral lymphatic invasion and axillary nodal metastasis. Breast Cancer. 23:712–717. 2016. View Article : Google Scholar : PubMed/NCBI

31 

Monteil J, Maubon A, Leobon S, Roux S, Marin B, Renaudie J, Genet D, Fermeaux V, Aubard Y and Tubiana-Mathieu N: Lymph node assessment with 18F-FDG-PET and MRI in uterine cervical cancer. Anticancer Res. 31:3865–3871. 2011.PubMed/NCBI

32 

Chen YB, Liao J, Xie R, Chen GL and Chen G: Discrimination of metastatic from hyperplastic pelvic lymph nodes in patients with cervical cancer by diffusion-weighted magnetic resonance imaging. Abdom Imaging. 36:102–109. 2011. View Article : Google Scholar : PubMed/NCBI

33 

Sala E, Rockall AG, Freeman SJ, Mitchell DG and Reinhold C: The added role of MR imaging in treatment stratification of patients with gynecologic malignancies: What the radiologist needs to know. Radiology. 266:717–740. 2013. View Article : Google Scholar : PubMed/NCBI

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Copy and paste a formatted citation
Spandidos Publications style
Gong J, Wang N, Bian L, Wang M, Ye M, Wen N, Fu M, Fan W and Meng Y: Cervical cancer evaluated with integrated 18F‑FDG PET/MR. Oncol Lett 18: 1815-1823, 2019.
APA
Gong, J., Wang, N., Bian, L., Wang, M., Ye, M., Wen, N. ... Meng, Y. (2019). Cervical cancer evaluated with integrated 18F‑FDG PET/MR. Oncology Letters, 18, 1815-1823. https://doi.org/10.3892/ol.2019.10514
MLA
Gong, J., Wang, N., Bian, L., Wang, M., Ye, M., Wen, N., Fu, M., Fan, W., Meng, Y."Cervical cancer evaluated with integrated 18F‑FDG PET/MR". Oncology Letters 18.2 (2019): 1815-1823.
Chicago
Gong, J., Wang, N., Bian, L., Wang, M., Ye, M., Wen, N., Fu, M., Fan, W., Meng, Y."Cervical cancer evaluated with integrated 18F‑FDG PET/MR". Oncology Letters 18, no. 2 (2019): 1815-1823. https://doi.org/10.3892/ol.2019.10514
Copy and paste a formatted citation
x
Spandidos Publications style
Gong J, Wang N, Bian L, Wang M, Ye M, Wen N, Fu M, Fan W and Meng Y: Cervical cancer evaluated with integrated 18F‑FDG PET/MR. Oncol Lett 18: 1815-1823, 2019.
APA
Gong, J., Wang, N., Bian, L., Wang, M., Ye, M., Wen, N. ... Meng, Y. (2019). Cervical cancer evaluated with integrated 18F‑FDG PET/MR. Oncology Letters, 18, 1815-1823. https://doi.org/10.3892/ol.2019.10514
MLA
Gong, J., Wang, N., Bian, L., Wang, M., Ye, M., Wen, N., Fu, M., Fan, W., Meng, Y."Cervical cancer evaluated with integrated 18F‑FDG PET/MR". Oncology Letters 18.2 (2019): 1815-1823.
Chicago
Gong, J., Wang, N., Bian, L., Wang, M., Ye, M., Wen, N., Fu, M., Fan, W., Meng, Y."Cervical cancer evaluated with integrated 18F‑FDG PET/MR". Oncology Letters 18, no. 2 (2019): 1815-1823. https://doi.org/10.3892/ol.2019.10514
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