Comparison of the validity of magnetic resonance imaging and positron emission tomography/computed tomography in the preoperative evaluation of patients with uterine corpus cancer
Introduction
Uterine corpus cancer is a common malignancy of the female genital tract, which is staged using the surgical staging system of the International Federation of Obstetrics and Gynecology (FIGO) [1]. The routine use and extent of lymphadenectomy has not yet been established in all patients with uterine corpus cancer. Among the methods used to preoperatively assess the presence of pelvic and paraaortic lymph nodes (LNs) are imaging modalities, such as magnetic resonance imaging (MRI) and computed tomography (CT), but the results of these methods are not satisfactory [2], [3]. Positron emission tomography (PET), which measures the increased metabolic activity of malignant cells rather than anatomic alterations, has been expected to have higher sensitivity than MRI or CT. In cervical, ovarian and vulvar cancer, many studies defining the validity of PET in diagnosing and staging patients have been published [4]. However, the role of PET in uterine corpus cancer is less defined because of the lack of published data in the literature [4]. To overcome the lower spatial resolution of PET compared with MRI or CT, a more advanced technique, fused positron emission tomography/computed tomography (PET/CT) was introduced [5], [6]. This method combines the anatomic detail provided by CT with PET metabolic information [5], [6]. To our knowledge, however, there have been no studies of PET/CT in the preoperative evaluation of patients with uterine corpus cancer. We therefore assessed the validity of PET/CT in the preoperative evaluation of patients with uterine corpus cancer and we compared the validity parameters of PET/CT with those of MRI.
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Study population
This clinicopathologic comparative study involved 53 patients with uterine corpus cancer who underwent a preoperative workup that included both MRI and PET/CT scans and who underwent surgical staging that included pelvic and/or paraaortic lymph node dissection between October 2004 and June 2007 at Asan Medical Center, Seoul, Korea. Their medical records were retrospectively reviewed, and surgical staging results were compared with preoperative findings on MRI and PET/CT. Initially, MRI was
Results
The patient population consisted of 53 women with uterine corpus cancer, who were diagnosed by endometrial biopsy and underwent preoperative evaluation, including both MRI and PET/CT, between endometrial biopsy and staging operation. Median patient age was 52 years (range, 27–68 years) and median body mass index was 24 kg/m2 (range, 18–40 kg/m2). Ten patients were nulliparous. The median time from endometrial biopsy to both MRI and PET/CT was 8 days (range, 1–27 days), and the median time from
Discussion
PET is a molecular imaging technique that uses radiolabeled molecules to image molecular interactions of biologic processes. Among several PET compounds available, the radiolabeled glucose analog FDG is the only tracer approved by the US Food and Drug Administration (FDA) for routine clinical use [7]. Tumor cells are associated with increased glycolysis and this metabolic property leads to increased uptake of radiolabeled FDG [8]. Although enhanced FDG uptake is not specific to malignant cells,
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