The feasibility of 18 F-FDG PET/CT for predicting pathologic risk status in early-stage uterine cervical squamous cancer
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RESEARCH ARTICLE
Open Access
The feasibility of 18F-FDG PET/CT for predicting pathologic risk status in earlystage uterine cervical squamous cancer Shuai Liu1,2,3,4†, Lingfang Xia2,5†, Ziyi Yang1,2,3,4, Huijuan Ge2,6, Chunmei Wang1,2,3,4, Herong Pan1,2,3,4, Shaoli Song1,2,3,4* and Zhengrong Zhou2,7*
Abstract Background: Postoperative pathologic risk factors (PRFs) could increase the recurrence rate in early-stage uterine cervical squamous cancer (ECSC). Our study intended to explore the efficiency of 18F-FDG PET/CT for assessing the pathologic risk status (PRS) in ECSC patients. Methods: This retrospective study was performed in 240 ECSC patients with stage IA2-IIA2 (FIGO 2009), who underwent preoperative PET/CT scans and subsequent radical surgery between January 2010 and July 2015. Intermediate-risk (tumour diameter ≥ 4 cm, stromal invasion depth ≥ 1/2, lymphovascular space invasion (LVSI)), and high-risk factors (parametria involvement, positive surgery margin, pelvic lymph node metastasis) were confirmed by postoperative pathology. Patients with none of these PRFs were at a low risk for relapse. One of these PRFs was defined as positive risk. The relationship between each PRF and 18F-FDG uptake was analysed by t-test. Chi-square tests and logistic regression analyses were used to determine the efficiency of PET/CT parameters for assessing the PRS. The area under the curve (AUC) was used as an indicator for predictive efficiency. Results: Patients with higher SUVmax (p < 0.001), MTV (p < 0.001) and TLG (p < 0.001) had larger tumour sizes and deeper stromal invasion. Further multivariate analyses showed SUVmax and TLG were independent predictors for positive- and intermediate-risk status. In high-risk group, MTV and TLG were associated with pelvic lymph node metastasis and parametria involvement. However, only MTV was a significant indicator. Conclusions: Preoperative Keywords:
18
18
F-FDG PET/CT had an independent predictive value for PRS in ECSC.
F-FDG, Surgical pathology, Risk factor, Uterine cervical cancer
* Correspondence: [email protected]; [email protected] † Shuai Liu and Lingfang Xia contributed equally to this work. 1 Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, No. 270, Dong’an Road, Xuhui District, Shanghai 20032, China 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's
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