Cervical Cancer Histology and Tumor Differentiation Affect 18F-Fluorodeoxyglucose Uptake

BACKGROUND: This study aimed to evaluate the variation in cervical cancer glucose metabolism for different tumor histologies and levels of differentiation, as measured by the uptake of F-18-fluorodeoxyglucose (FDG) by positron emission tomography (PET). METHODS: The study population consisted of 240 patients with International Federation of Gynecology and Obstetrics stages lb1 through IVb cervical cancer, who underwent a pretreatment FDG-PET, Tumor histology included 221 squamous cell (SC), 4 adenosquamous (AS), and 15 adenocarcinoma (AC) tumors. There were 14 well, 145 moderately, and 81 poorly differentiated tumors, The stage distribution was as follows: 70 stage I tumors (9 AC, 2 AS, and 59 SC), 102 stage 11 tumors (3 AC, I AS, and 98 SQ, 64 stage III tumors (3 AC, 1 AS, and 60 SC), and 4 stage IV tumors (4 SQ. From the FDG-PET, maximal standardized uptake value (SUVmax) was determined. The variation in SUVmax was analyzed for differences based on tumor histology and differentiation. RESULTS: For all patients, the mean SUVmax was 11.62 (range, 2.50-50.39). The mean SUVmax by histology was as follows: SC, 11.91 (range, 2.50-50.39); AS, 8.85 (range, 6.53-11.26): and AC, 8.05 (range, 2.83-13.92). Squamous versus nonsquamous tumors demonstrated a significant difference in SUVmax (P = .0153). SUVmax and tumor volume were not found to be correlated (R-2 = 0.013). The mean SUVmax was 8.58 for well-differentiated, 11.56 for moderately differentiated, and 12.23 for poorly differentiated tumors. The mean SUVmax was significantly different for well-differentiated versus poorly differentiated cervical tumors (P = .0474), CONCLUSIONS: Cervical tumor FDG uptake varied by histology and differentiation. SC tumors demonstrated a significantly higher SUVmax compared with nonsquamous cell tumors, and poorly differentiated tumors also had a higher SUVmax. Cancer 2009;115:3548-54. (C) 2009 American Cancer Society.