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Nuklearmedizin 2020; 59(03): 241-247
DOI: 10.1055/a-1084-4766
Original Article

Comparison of semiquantitative metabolic parameters of the primary tumor obtained in PET/CT with 18F-FDG and 18F-FLT in patients with cervical cancer

Vergleich der semiquantitativen Stoffwechselparameter des Primärtumors im PET/CT mit 18F-FDG und 18F-FLT bei Patienten mit Gebärmutterhalskrebs
Paulina Cegła
1   Department of Nuclear Medicine, Greater Poland Cancer Centre, Poznan, Poland
,
Ewa Burchardt
2   Department of Radiotherapy and Oncological Gynaecology, Greater Poland Cancer Centre, Poznan, Poland
,
Witold Cholewiński
3   Chair and Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland
1   Department of Nuclear Medicine, Greater Poland Cancer Centre, Poznan, Poland
,
Sebastian Gwóźdź
1   Department of Nuclear Medicine, Greater Poland Cancer Centre, Poznan, Poland
,
Andrzej Roszak
3   Chair and Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland
2   Department of Radiotherapy and Oncological Gynaecology, Greater Poland Cancer Centre, Poznan, Poland
,
Anna Kubiak
4   Greater Poland Cancer Registry, Greater Poland Cancer Centre, Poznan, Poland
,
Aleksandra Kaczmarek
1   Department of Nuclear Medicine, Greater Poland Cancer Centre, Poznan, Poland
3   Chair and Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland
,
Rafał Czepczyński
5   Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
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Abstract

Aim The aim of the study was to compare semiquantitative metabolic parameters of primary tumor assessed in vivo in 18F-FDG- and 18F-FLT in cervical cancer patients.

Material & Methods 39 patients with histologically confirmed cervical cancer underwent PET/CT scans acquired on separate days 60 min after i. v. injection of 364 ± 75 MBq of 18F-FDG and 259 ± 40 MBq of 18F-FLT. The reconstructed PET images were evaluated using a dedicated workstation for primary tumor semiquantitative parameters: SUVmax, MTV, TLG (for 18F-FLT-TLP) and heterogeneity (AUC-CSH). Wilcoxon-Mann-Whitney test and ROC curves were used for statistical analysis. Based on data from the local cancer registry and 3y- to -5y follow up patients were divided into 2 groups with regard to prognosis. Also differences between histopathological type and FIGO classification in two tracers were assessed.

Results Depending on PET/CT results, patients were divided into 3 groups: group 1 with disease limited only to the cervix, group 2 with disease limited to the cervix and iliac lymph nodes, and group 3 with disseminated disease. Statistically significant differences were found between keratinizing and non-keratinizing SCC in SUVmax (p = 0.03) and AUC-CSH (p = 0.04) only in 18F-FLT-PET/CT. Following cut-off values for nodal involvement in SUVmax, MTV, TLG/TLP and AUC-CSH were calculated using ROC curves: 13.5, 39.22, 255.94, 0.59 respectively for 18F-FDG and 12.1, 37.59, 140.01, 0.46 respectively for 18F-FLT. Higher values in both tracers in MTV and TLG/TLP were found in a group with worse prognosis.

Conclusion This preliminary study suggests that higher values in MTV and TLG/TLP in both tracers might be associated with worse outcome in cervical cancer patients.

Zusammenfassung

Ziel Vergleich semiquantitativer Stoffwechselparameter von Primärtumoren, die in vivo mit 18F-FDG- und 18F-FLT bei Patienten mit Gebärmutterhalskrebs untersucht wurden.

Material & Methoden Bei 39 Patienten mit histologisch bestätigtem Gebärmutterhalskrebs wurden PET/CT-Untersuchungen an verschiedenen Tagen jeweils 60 Minuten nach der i.v. Injektion von 364 ± 75 MBq 18F-FDG und von 259 ± 40 MBq 18F-FLT durchgeführt. Die rekonstruierten PET-Bilder wurden mit einer speziellen Workstation in Bezug auf semiquantitative Parameter des Primärtumors ausgewertet: SUVmax, MTV, TLG (für 18F-FLT-TLP) und Heterogenität (AUC-CSH). Für die statistische Analyse wurden der Wilcoxon-Mann-Whitney-Test und ROC-Kurven verwendet. Basierend auf den Daten aus dem lokalen Krebsregister und der 3- bis 5-jährigen Nachsorge wurden die Patienten in zwei Gruppen hinsichtlich der Prognose eingeteilt. Außerdem wurden die Unterschiede zwischen histopathologischen Typ und FIGO-Klassifikation mit zwei Tracern bewertet.

Ergebnisse In Abhängigkeit von den PET/CT-Ergebnissen wurden die Patienten in drei Gruppen eingeteilt: In Gruppe 1 war die Erkrankung nur auf den Gebärmutterhals beschränkt, in Gruppe 2 auf den Gebärmutterhals und die Beckenlymphknoten und in Gruppe 3 bestand eine disseminierte Erkrankung. Nur im 18F-FLT-PET/CT wurden statistisch signifikante Unterschiede zwischen keratinisierenden und nicht-keratinisierenden SCC für SUVmax (p = 0,03) und AUC-CSH (p = 0,04) gefunden. Nach den Grenzwerten für die nodale Beteiligung ergaben sich unter Verwendung von ROC-Kurven folgende Parameter: SUVmax: 13,5; MTV: 39,22; TLG/TLP: 255,94 und AUC-CSH: 0,59 für 18F-FDG bzw. SUVmax: 12,1; MTV: 37,59; TLG/TLP: 140,01; AUC-CSH: 0,46 für 18F-FLT. Höhere Werte für MTV und TLG/TLP wurden in einer Gruppe mit schlechterer Prognose mit beiden Tracern gefunden.

Schlussfolgerung Diese vorläufige Studie legt nahe, dass höhere MTV- und TLG/TLP-Werte mit beiden Tracern bei Patienten mit Gebärmutterhalskrebs mit einem schlechteren Outcome assoziiert sein könnten.

Key words

oncology - positron emission tomography/computed tomography - 18F-Fluorothymidine - 18F-Fluorodeoxyglucose - cervical cancer

Schlüsselwörter

Onkologie - 18F-Fluorthymidin - 18F-Fluordesoxyglucose - Gebärmutterhalskrebs - Positronen-Emissions-Tomographie/Computertomographie


Publication History

Article published online:
25 February 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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