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Differentiation of aggressive and indolent subtypes of uterine sarcoma using maximum standardized uptake value.

Lee EY, Khong PL, Tse KY, Chan KK, Chu MM, Ngan HY - Nucl Med Commun (2013)

Bottom Line: We calculated the optimal cutoff value as determined by receiver operating characteristic analysis.A P-value less than 0.05 was considered statistically significant.The mean SUV max of aggressive (n=104) and indolent tumours (n=30) were significantly different (8.0 ± 7.3 vs. 1.9 ± 0.9 respectively; P<0.001).

View Article: PubMed Central - PubMed

Affiliation: Departments of aDiagnostic Radiology bObstetrics and Gynaecology, Queen Mary Hospital, University of Hong Kong, Pokfulam Road, Hong Kong.

ABSTRACT

Objective: The aim of the study was to elucidate the differential metabolic activities in aggressive and indolent subtypes of uterine sarcomas, which may aid in managing these heterogeneous tumours.

Methods: We retrospectively analysed the PET/computed tomography scans of consecutive patients (N=18) diagnosed with uterine sarcoma at our unit. The patients were divided into indolent (N=4) and aggressive (N=14) tumour groups, and the maximum standardized uptake values (SUV max) of all lesions (n=134) were measured. The SUV max of the lesions were compared between the two tumour groups using the Mann-Whitney U-test. We calculated the optimal cutoff value as determined by receiver operating characteristic analysis. A P-value less than 0.05 was considered statistically significant.

Results: The mean SUV max of aggressive (n=104) and indolent tumours (n=30) were significantly different (8.0 ± 7.3 vs. 1.9 ± 0.9 respectively; P<0.001). A cutoff of SUV max greater than 4.0 was able to exclude indolent tumours, with 100% specificity and positive predictive value (sensitivity 72%, negative predictive value 50% and accuracy 78%; area under the curve 97%). By applying this same cutoff value on the most metabolic active lesion in each patient, we were able to correctly classify all but one patient into either the aggressive or indolent tumour group with 100% specificity and positive predictive value (sensitivity 93%, negative predictive value 80% and accuracy 94%).

Conclusion: Aggressive and indolent uterine sarcoma subtypes have differential metabolic activities that can be used to classify them and this can aid in patient management for preoperative surgical planning and treatment stratification.

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Related in: MedlinePlus

The box plot shows the SUVmax of lesions in the indolent and aggressive groups of uterine sarcoma; the difference was statistically significant. The grey boxes represent the 25th–75th percentiles of the SUVmax, and the crossbars denote the minimum and maximum values that were not outliers. The asterisks are the extreme outliers and the circle represents the mild outlier. Values adjacent to the asterisks and circle are the absolute SUVmax of the outliers. SUVmax, maximum standardized uptake value.
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Figure 1: The box plot shows the SUVmax of lesions in the indolent and aggressive groups of uterine sarcoma; the difference was statistically significant. The grey boxes represent the 25th–75th percentiles of the SUVmax, and the crossbars denote the minimum and maximum values that were not outliers. The asterisks are the extreme outliers and the circle represents the mild outlier. Values adjacent to the asterisks and circle are the absolute SUVmax of the outliers. SUVmax, maximum standardized uptake value.

Mentions: There were 30 lesions in the indolent group with an SUVmax of 1.9±0.9 (range 0.5–4.0) and 104 lesions in the aggressive group with an SUVmax of 8.0±7.3 (range 1.8–34.9). The difference in metabolic activities between the two groups was statistically significant (Mann–Whitney U-test, P<0.001), as illustrated in Fig. 1. After excluding the outliers from analysis, the result remained statistically significant (Mann–Whitney U-test, P<0.001). When the most-avid lesion was selected from each patient from the two subgroups and compared, the difference remained statistically significant: SUVmax 3.0±0.9 (range 1.9–4.0) versus 10.6±7.9 (range 1.8–34.9) for indolent and aggressive tumours, respectively (Mann–Whitney U-test, P=0.008).


Differentiation of aggressive and indolent subtypes of uterine sarcoma using maximum standardized uptake value.

Lee EY, Khong PL, Tse KY, Chan KK, Chu MM, Ngan HY - Nucl Med Commun (2013)

The box plot shows the SUVmax of lesions in the indolent and aggressive groups of uterine sarcoma; the difference was statistically significant. The grey boxes represent the 25th–75th percentiles of the SUVmax, and the crossbars denote the minimum and maximum values that were not outliers. The asterisks are the extreme outliers and the circle represents the mild outlier. Values adjacent to the asterisks and circle are the absolute SUVmax of the outliers. SUVmax, maximum standardized uptake value.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3815224&req=5

Figure 1: The box plot shows the SUVmax of lesions in the indolent and aggressive groups of uterine sarcoma; the difference was statistically significant. The grey boxes represent the 25th–75th percentiles of the SUVmax, and the crossbars denote the minimum and maximum values that were not outliers. The asterisks are the extreme outliers and the circle represents the mild outlier. Values adjacent to the asterisks and circle are the absolute SUVmax of the outliers. SUVmax, maximum standardized uptake value.
Mentions: There were 30 lesions in the indolent group with an SUVmax of 1.9±0.9 (range 0.5–4.0) and 104 lesions in the aggressive group with an SUVmax of 8.0±7.3 (range 1.8–34.9). The difference in metabolic activities between the two groups was statistically significant (Mann–Whitney U-test, P<0.001), as illustrated in Fig. 1. After excluding the outliers from analysis, the result remained statistically significant (Mann–Whitney U-test, P<0.001). When the most-avid lesion was selected from each patient from the two subgroups and compared, the difference remained statistically significant: SUVmax 3.0±0.9 (range 1.9–4.0) versus 10.6±7.9 (range 1.8–34.9) for indolent and aggressive tumours, respectively (Mann–Whitney U-test, P=0.008).

Bottom Line: We calculated the optimal cutoff value as determined by receiver operating characteristic analysis.A P-value less than 0.05 was considered statistically significant.The mean SUV max of aggressive (n=104) and indolent tumours (n=30) were significantly different (8.0 ± 7.3 vs. 1.9 ± 0.9 respectively; P<0.001).

View Article: PubMed Central - PubMed

Affiliation: Departments of aDiagnostic Radiology bObstetrics and Gynaecology, Queen Mary Hospital, University of Hong Kong, Pokfulam Road, Hong Kong.

ABSTRACT

Objective: The aim of the study was to elucidate the differential metabolic activities in aggressive and indolent subtypes of uterine sarcomas, which may aid in managing these heterogeneous tumours.

Methods: We retrospectively analysed the PET/computed tomography scans of consecutive patients (N=18) diagnosed with uterine sarcoma at our unit. The patients were divided into indolent (N=4) and aggressive (N=14) tumour groups, and the maximum standardized uptake values (SUV max) of all lesions (n=134) were measured. The SUV max of the lesions were compared between the two tumour groups using the Mann-Whitney U-test. We calculated the optimal cutoff value as determined by receiver operating characteristic analysis. A P-value less than 0.05 was considered statistically significant.

Results: The mean SUV max of aggressive (n=104) and indolent tumours (n=30) were significantly different (8.0 ± 7.3 vs. 1.9 ± 0.9 respectively; P<0.001). A cutoff of SUV max greater than 4.0 was able to exclude indolent tumours, with 100% specificity and positive predictive value (sensitivity 72%, negative predictive value 50% and accuracy 78%; area under the curve 97%). By applying this same cutoff value on the most metabolic active lesion in each patient, we were able to correctly classify all but one patient into either the aggressive or indolent tumour group with 100% specificity and positive predictive value (sensitivity 93%, negative predictive value 80% and accuracy 94%).

Conclusion: Aggressive and indolent uterine sarcoma subtypes have differential metabolic activities that can be used to classify them and this can aid in patient management for preoperative surgical planning and treatment stratification.

Show MeSH
Related in: MedlinePlus