SUVmax of 18FDG PET/CT as a predictor of high-risk endometrial cancer patients

ObjectiveTo evaluate SUVmax in the assessment of endometrial cancer preoperatively with particular focus on myometrial invasion (MI), cervical invasion (CI), FIGO stage, risk-stratification and lymph node metastases (LNM).MethodsA total of 268 women with endometrial cancer or atypical endometrial hyperplasia underwent FDG PET/CT imaging before surgical treatment. SUVmax of the primary tumour was compared with histological prognostic factors.ResultsSUVmax was significantly higher in patients with high FIGO stages (p < 0.0001), deep MI (p = 0.002), CI (p = 0.04), LNM (p = 0.04) and high risk tumours (p = 0.003). Linear regression found that SUVmax was dependent of MI (p = 0.001, 95% CI 2.863–11.098), CI (p = 0.001, 95% CI 2.896–11.499), risk (p = 0.004, 95% CI 0.077–0.397), LNM (p = 0.04, 95% CI 0.011–0.482) and FIGO stage (p < 0.0001, 95% CI 0.158–0.473).ConclusionsPreoperative PET/CT scanning and SUVmax measurements of the primary tumour may provide additional clinical and prognostic information about MI, CI, LNM and high risk disease in patients with endometrial cancer and allow for individualization of patient care. However, the sensitivity and specificity of the SUVmax in staging endometrial cancer is not high enough to reliably replace surgical staging.

► SUVmax was significantly higher in high risk endometrial cancer patients.
► SUVmax was positively correlated to known prognostic factors for endometrial cancer.
► SUVmax can be used in the multidisciplinary work-up of endometrial cancer patients.