Presurgical Identification of Uterine Smooth Muscle Malignancies through the Characteristic FDG Uptake Pattern on PET Scans

Kung Chu Ho, Yu Hua Dean Fang, Gigin Lin, Shir Hwa Ueng, Tzu I. Wu, Chyong Huey Lai, Ho Yen Chueh, Angel Chao, Ting Chang Chang, Tzu Chen Yen

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Abstract

The unidentified presence of uterine smooth muscle malignancies poses a tremendous risk in women planning surgery for presumed benign leiomyomas. We sought to investigate whether preoperative FDG PET may be useful to identify leiomyosarcomas (LMS) and smooth muscle tumors of uncertain malignant potential (STUMP). Methods. We investigated patients with rapidly growing uterine masses which were suspected of being malignant on ultrasound or MRI. Among the 21 patients who underwent FDG PET, we identified 7 LMS, 1 STUMP, and 13 leiomyomas. PET-derived parameters and FDG uptake patterns were analyzed retrospectively. Results. The SUVmax values of LMS/STUMP (range: 3.7-11.8) were significantly higher than those observed in leiomyomas (range: 2.0-9.4; P=0.003) despite a significant overlap. The metabolic tumor/necrosis ratio was significantly higher in LMS/STUMP than in leiomyomas (P<0.001), with no significant intergroup overlaps. All LMS/STUMP revealed a characteristic pattern of FDG uptake, identifying a specific "hollow ball" sign (corresponding to areas of coagulative tumor necrosis). In contrast, this sign was invariably absent in patients with leiomyomas. Conclusion. The characteristic FDG uptake pattern instead of SUV on PET images allows identifying LMS/STUMP in patients with rapidly growing uterine masses, avoiding the deleterious consequences of regular surgery for presumed benign leiomyomas.

Original languageEnglish
Article number7890241
JournalContrast Media and Molecular Imaging
Volume2018
DOIs
Publication statusPublished - Jun 19 2018

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Smooth Muscle Tumor
Leiomyosarcoma
Myometrium
Leiomyoma
Positron-Emission Tomography
Smooth Muscle
Neoplasms
Necrosis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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Presurgical Identification of Uterine Smooth Muscle Malignancies through the Characteristic FDG Uptake Pattern on PET Scans. / Ho, Kung Chu; Dean Fang, Yu Hua; Lin, Gigin; Ueng, Shir Hwa; Wu, Tzu I.; Lai, Chyong Huey; Chueh, Ho Yen; Chao, Angel; Chang, Ting Chang; Yen, Tzu Chen.

In: Contrast Media and Molecular Imaging, Vol. 2018, 7890241, 19.06.2018.

Research output: Contribution to journalArticle

Ho, Kung Chu ; Dean Fang, Yu Hua ; Lin, Gigin ; Ueng, Shir Hwa ; Wu, Tzu I. ; Lai, Chyong Huey ; Chueh, Ho Yen ; Chao, Angel ; Chang, Ting Chang ; Yen, Tzu Chen. / Presurgical Identification of Uterine Smooth Muscle Malignancies through the Characteristic FDG Uptake Pattern on PET Scans. In: Contrast Media and Molecular Imaging. 2018 ; Vol. 2018.
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abstract = "The unidentified presence of uterine smooth muscle malignancies poses a tremendous risk in women planning surgery for presumed benign leiomyomas. We sought to investigate whether preoperative FDG PET may be useful to identify leiomyosarcomas (LMS) and smooth muscle tumors of uncertain malignant potential (STUMP). Methods. We investigated patients with rapidly growing uterine masses which were suspected of being malignant on ultrasound or MRI. Among the 21 patients who underwent FDG PET, we identified 7 LMS, 1 STUMP, and 13 leiomyomas. PET-derived parameters and FDG uptake patterns were analyzed retrospectively. Results. The SUVmax values of LMS/STUMP (range: 3.7-11.8) were significantly higher than those observed in leiomyomas (range: 2.0-9.4; P=0.003) despite a significant overlap. The metabolic tumor/necrosis ratio was significantly higher in LMS/STUMP than in leiomyomas (P<0.001), with no significant intergroup overlaps. All LMS/STUMP revealed a characteristic pattern of FDG uptake, identifying a specific {"}hollow ball{"} sign (corresponding to areas of coagulative tumor necrosis). In contrast, this sign was invariably absent in patients with leiomyomas. Conclusion. The characteristic FDG uptake pattern instead of SUV on PET images allows identifying LMS/STUMP in patients with rapidly growing uterine masses, avoiding the deleterious consequences of regular surgery for presumed benign leiomyomas.",
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