Parameters of simultaneous 18 F-FDG-PET/MRI predict tumor stage and several histopathological features in uterine cervical cancer

// Alexey Surov 1 , Hans Jonas Meyer 1 , Stefan Schob 1 , Anne-Kathrin Hohn 2 , Kristina Bremicker 1 , Marc Exner 1 , Patrick Stumpp 1 , Sandra Purz 3 1 Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, 04103 Leipzig, Germany 2 Department of Pathology University Hospital of Leipzig, 04103 Leipzig, Germany 3 Department of Nuclear Medicine, University Hospital of Leipzig, 04103 Leipzig, Germany Correspondence to: Alexey Surov, email: alex.surow@medizin.uni-halle.de Keywords: uterine cervical cancer, PET, DWI, cell count, KI 67 Received: February 07, 2017      Accepted: February 27, 2017      Published: March 09, 2017 ABSTRACT 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 simultaneous 18 F-FDG PET/MRI. Mean and maximum SUV were noted (SUV mean and SUV max ). In all tumors minimal, mean, and maximal ADC values (ADC min , ADC mean , and ADC max ) were estimated. Combined parameters were calculated: SUV max /SUV mean, ADC min / ADC mean, SUV max /ADC min and SUV max /ADC mean. 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 value s ≤ 0.05 were considered as statistically significant. ADC min and ADC min / ADC mean were statistically significant lower in N positive tumors. KI 67 correlated statistically significant with SUV max (r = 0.59, p = 0.005), SUV mean (0.45, p = 0.04), ADC min (r = –0.48, p = 0.03), SUV max /ADC min (r = 0.71, p = 0.001), SUV max /ADC mean (0.75, p = 0.001). SUV max correlated well with epithelial area (r = 0.71, p = 0.001) and stromal areas (r = –0.71, p = 0.001). SUV values, ADC min , SUV max /ADC min and SUV max /ADC mean 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.