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[18]Fluorodeoxyglucose Positron Emission Tomography for the Textural Features of Cervical Cancer Associated with Lymph Node Metastasis and Histological Type

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Abstract

Background

In this study, we investigated the correlation between the lymph node (LN) status or histological types and textural features of cervical cancers on 18F-fluorodeoxyglucose positron emission tomography/computed tomography.

Methods

We retrospectively reviewed the imaging records of 170 patients with International Federation of Gynecology and Obstetrics stage IB–IVA cervical cancer. Four groups of textural features were studied in addition to the maximum standardized uptake value (SUVmax), metabolic tumor volume, and total lesion glycolysis (TLG). Moreover, we studied the associations between the indices and clinical parameters, including the LN status, clinical stage, and histology. Receiver operating characteristic curves were constructed to evaluate the optimal predictive performance among the various textural indices. Quantitative differences were determined using the Mann–Whitney U test. Multivariate logistic regression analysis was performed to determine the independent factors, among all the variables, for predicting LN metastasis.

Results

Among all the significant indices related to pelvic LN metastasis, homogeneity derived from the gray-level co-occurrence matrix (GLCM) was the sole independent predictor. By combining SUVmax, the risk of pelvic LN metastasis can be scored accordingly. The TLGmean was the independent feature of positive para-aortic LNs. Quantitative differences between squamous and nonsquamous histology can be determined using short-zone emphasis (SZE) from the gray-level size zone matrix (GLSZM).

Conclusion

This study revealed that in patients with cervical cancer, pelvic or para-aortic LN metastases can be predicted by using textural feature of homogeneity from the GLCM and TLGmean, respectively. SZE from the GLSZM is the sole feature associated with quantitative differences between squamous and nonsquamous histology.

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Abbreviations

PET/CT:

Positron emission tomography/computed tomography

SUVmax :

maximum standardized uptake value

TLG:

total lesion glycolysis

MTV:

metastatic tumor volume

SZE:

short-zone emphasis

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Acknowledgements

This study was supported in part by the Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW106-TDU-B-212-113004); China Medical University Hospital, Academia Sinica Taiwan Biobank Stroke Biosignature Project (BM10501010037); NRPB Stroke Clinical Trial Consortium (MOST105-2325-B-039-003); Tseng-Lien Lin Foundation (Taichung, Taiwan); Taiwan Brain Disease Foundation (Taipei, Taiwan); Katsuzo and Kiyo Aoshima Memorial Funds, Japan; Taiwan Ministry of Science and Technology (MOST 105-2218-E-009-034); and Asia University, Taichung, Taiwan (ASIA-105-CMUH-14); and Welfare Surcharge of Tobacco Products, China Medical University Hospital Cancer Research Center of Excellence (MOHW105-TDU-B-212-134-003, Taiwan). The funders played no role in the study design, data collection and analysis, publication decision, or manuscript drafting. No additional external funding was received for this study.

Author information

Author notes

  1. Shang-Wen Chen and Wei-Chih Shen are equally contributory to this article.

Authors and Affiliations

  1. Department of Computer Science and Information Engineering, Asia University, Taichung, Taiwan

    Wei-Chih Shen

  2. Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan

    Shang-Wen Chen & Ji-An Liang

  3. School of Medicine, China Medical University, Taichung, Taiwan

    Shang-Wen Chen

  4. School of Medicine, Taipei Medical University, Taipei, Taiwan

    Shang-Wen Chen

  5. Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 40447, Taiwan, Republic of China

    Shang-Wen Chen, Ji-An Liang & Chia-Hung Kao

  6. Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan

    Te-Chun Hsieh, Kuo-Yang Yen & Chia-Hung Kao

  7. Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan

    Te-Chun Hsieh & Kuo-Yang Yen

  8. Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan

    Chia-Hung Kao

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Contributions

WC Shen, SW Chen, and CH Kao were responsible for design of the study. All authors collected the data. SW Chen, WC Shen, and CH Kao carried out statistical analysis, interpretation of data, and drafting the article. All authors provided some intellectual content. SW Chen, WC Shen, and CH Kao approved the version to be submitted. All authors read and approved the final manuscript. SW Chen and WC Shen are equally contributory to this article.

Corresponding author

Correspondence to Chia-Hung Kao.

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Conflict of interest

All authors declare no conflicts of interest.

Ethical approval

This study was approved by a local institutional review board DMR99-IRB-010(CR6).

Informed consent

The institutional review board specifically waived the consent requirement.

Electronic supplementary material

Appendix 1.

Indices calculated from the textural analysis. The performance of a texture index in predicting the PLN metastasis was evaluated by the area under the ROC curve. To evaluate the performance of a discretization method, the average and standard deviation of all areas of each texture index acquired from all parameters of the discretization method were calculated. (DOCX 18 kb)

Appendix 2.

Textural indices that showed a varying trend between patients with FIGO stages I and II and III–IVA. (DOCX 18 kb)

Appendix 3.

According to pelvic lymph node (PLN) metastasis, (a) the scatterplot of the MTV and homogeneity and (b) that of the TLGmean and homogeneity of the primary tumors. The largest tumor with an MTV of 449.962.3 mm3 with PLN metastasis was excluded from the scatterplot (a), as detailed on the y-axis. (DOCX 3742 kb)

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Shen, WC., Chen, SW., Liang, JA. et al. [18]Fluorodeoxyglucose Positron Emission Tomography for the Textural Features of Cervical Cancer Associated with Lymph Node Metastasis and Histological Type. Eur J Nucl Med Mol Imaging 44, 1721–1731 (2017). https://doi.org/10.1007/s00259-017-3697-1

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  • DOI: https://doi.org/10.1007/s00259-017-3697-1

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