Parameters of simultaneous 18F-FDG-PET/MRI predict tumor stage and several histopathological features in uterine cervical cancer
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Alexey Surov1, Hans Jonas Meyer1, Stefan Schob1, Anne-Kathrin Höhn2, Kristina Bremicker1, Marc Exner1, Patrick Stumpp1, Sandra Purz3
1Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, 04103 Leipzig, Germany
2Department of Pathology University Hospital of Leipzig, 04103 Leipzig, Germany
3Department of Nuclear Medicine, University Hospital of Leipzig, 04103 Leipzig, Germany
Alexey Surov, email: firstname.lastname@example.org
Keywords: uterine cervical cancer, PET, DWI, cell count, KI 67
Received: February 07, 2017 Accepted: February 27, 2017 Published: March 09, 2017
The purpose of this study was to analyze associations between apparent diffusion coefficient (ADC) and standardized uptake values (SUV) values and different histopathological parameters in uterine cervical cancer. 21 patients with primary uterine cervical cancer were involved into the study. All patients underwent a whole body simultaneous18F-FDG PET/MRI. Mean and maximum SUV were noted (SUVmean and SUVmax). In all tumors minimal, mean, and maximal ADC values (ADCmin, ADCmean, and ADCmax) were estimated. Combined parameters were calculated: SUVmax/SUVmean, ADCmin/ ADCmean, SUVmax/ADCmin and SUVmax/ADCmean. In all cases the diagnosis was confirmed histopathologically by tumor biopsy. Histological slices were stained by hematoxilin and eosin, MIB 1 monoclonal antibody, and p16. All histopathological images were digitalized and analyzed by using a ImageJ software 1.48v. The following parameters were estimated: cell count, proliferation index KI 67, total and average nucleic areas, epithelial and stromal areas. Spearman’s correlation coefficient was used to analyze associations between ADC and SUV values and histological parameters. P values ≤ 0.05 were considered as statistically significant. ADCmin and ADCmin/ ADCmean were statistically significant lower in N positive tumors. KI 67 correlated statistically significant with SUVmax (r = 0.59, p = 0.005), SUVmean (0.45, p = 0.04), ADCmin (r = –0.48, p = 0.03), SUVmax/ADCmin (r = 0.71, p = 0.001), SUVmax/ADCmean (0.75, p = 0.001). SUVmax correlated well with epithelial area (r = 0.71, p = 0.001) and stromal areas (r = –0.71, p = 0.001). SUV values, ADCmin, SUVmax/ADCmin and SUVmax/ADCmean correlated statistically significant with KI 67 and can be used to estimate the proliferation potential of tumors. SUV values correlated strong with epithelial area of tumor reflected metabolic active areas.
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