[18F]FDG and [18F]FES positron emission tomography for disease monitoring and assessment of anti-hormonal treatment eligibility in granulosa cell tumors of the ovary
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Joline F. Roze1, Hannah S. van Meurs2, Glen R. Monroe1, Wouter B. Veldhuis3, Luc R.C.W. van Lonkhuijzen2, Roel J. Bennink4, Jolijn W. Groeneweg1, Petronella O. Witteveen5, Geertruida N. Jonges6, Ronald P. Zweemer1 and Arthur J.A.T. Braat7
1 Department of Gynecological Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
2 Department of Gynecological Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
3 Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
4 Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
5 Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
6 Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
7 Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
|Joline F. Roze,||email:||J.F.Rozefirstname.lastname@example.org|
Keywords: positron emission tomography (PET); 18F-fluoroestradiol (18F-FES); 18F-fluoro-deoxyglucose (18F-FDG); granulosa cell tumors (GCTs); hormone receptors
Received: January 30, 2021 Accepted: March 15, 2021 Published: March 30, 2021
Purpose: Adult granulosa cell tumors (AGCTs) of the ovary represent a rare malignancy in which timing and choice of treatment is a clinical challenge. This study investigates the value of FDG-PET/CT and FES-PET/CT in monitoring recurrent AGCTs and assessing eligibility for anti-hormonal treatment.
Materials and Methods: We evaluated 22 PET/CTs from recurrent AGCT patients to determine tumor FDG (n = 16) and FES (n = 6) uptake by qualitative and quantitative analysis. We included all consecutive patients from two tertiary hospitals between 2003-2020. Expression of ERα and ERβ and mitoses per 2 mm2 were determined by immunohistochemistry and compared to FES and FDG uptake, respectively.
Results: Qualitative assessment showed low-to-moderate FDG uptake in most patients (14/16), and intense uptake in 2/16. One patient with intense tumor FDG uptake had a high mitotic rate (18 per 2 mm2) Two out of six patients showed FES uptake on PET/CT at qualitative analysis. Lesion-based quantitative assessment showed a mean SUVmax of 2.4 (± 0.9) on FDG-PET/CT and mean SUVmax of 1.7 (± 0.5) on FES-PET/CT. Within patients, expression of ERα and ERβ varied and did not seem to correspond with FES uptake. In one FES positive patient, tumor locations with FES uptake remained stable or decreased in size during anti-hormonal treatment, while all FES negative locations progressed.
Conclusions: This study shows that in AGCTs, FDG uptake is limited and therefore FDG-PET/CT is not advised. FES-PET/CT may be useful to non-invasively capture the estrogen receptor expression of separate tumor lesions and thus assess the potential eligibility for hormone treatment in AGCT patients.
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