Validity of F-18 FDG PET/CT for preoperative evaluation of endometrial cancer

Objective: The purpose is to compare SUVvalues of dual phase F-18 FDG PET/CT in preoperative staging of endometrial cancer patients with CA125 values, pathology, MR and to evaluate accuracy of F-18 FDG PET in myometrial invasion.Methods: We retrospectively reviewed medical records and images of 30 postmenopausal women with endometrial carcinoma who underwent preoperative dual phase FDG PET-CT between December 2008 and September 2009 in DEUTF Department of Nuclear Medicine. Different SUV values (early and late SUVmax-mean-min, ROI1.2SUVmax-mean-min ve SUVTotal) and retention index were calculated. We compared F-18 FDG PET/CT results in staging, detecting myometrial invasion and lymph node metastasis with pathology, MR and CA125 values.Results: Mean age of 30 postmenopausal patients with endometrial carcinoma was 59±9(43-76). Based on the surgical 2002 FIGO staging system, nine patients were stage 1A, 10 patients were stage 1B, two patients were stage 1C, six patients were stage 3C, one patient was stage 2B, 3A and 4B each. Mean SUVmax of primary lesions was 13.3±7. We found correlation of PET-CT with stage, myometrial invasion and lymph node metastasis. Using 8.6 as a cut-off value for SUVmax to determine the presence or absence of myometrial invasion, PET/CT had 90% sensitivity, 89% specificity. Using 1282 as a cut-off value for SUV1Total to determine the superficial or deep invasion, PET/CT had 90% sensitivity, 89% specificity. Sensitivity, specificity, PPV, NPV and accuracy of PET/CT for detecting lmyph node metastasis were 85%, 100%, 100%, 95% and 96%, respectively. Sensitivity, specificity, PPV, NPV and accuracy of MR for detecting lmyph node metastasis were 57%, 100%, 100%, 88% and 90%, respectively.Conclusion: F-18 FDG PET-CT can be useful for the management of patients with endometrium carcinoma because of presence of correlations with prognostic factors, accuracy in detecting lymph node metastasis and myometrial invasion and the ability of scanning the whole body. Retention index, late images, SUVmin and ROI1.2cmSUV values were found not useful in evaluating endometrial carcinoma.