Evaluation of 18FDG PET-CT in the Diagnosis of Endometriosis: A Prospective Study

Background: Noninvasive techniques have poor sensitivity and specificity in diagnosing endometriosis, which is often associated with an inflammatory process. In several benign diseases, measurement of hypermetabolism using fluorodeoxyglucose (18F18FDG) reflects the degree of inflammation and aggressiveness of the disease. This prospective study evaluated the value of 18FDG positron emission tomography (PET)-computed tomography (CT) in assessing the presence of endometriosis. Methods: Ten consecutive patients suspected with endometriosis were prospectively included in this study. A preoperative 18FDG PET-CT was performed in all the patients during the follicular phase of their cycle, which preceded laparoscopic surgery. Surgical endometriosis staging and histopathological analysis of removed tissue were confronted with the results from 18FDG PET-CT. Results: Of the 10 patients, 9 had endometriosis confirmed by laparoscopy; 6 had advanced stage of the disease and 5 had histologically proven lesions. Nevertheless, none of the patients had 18FDG-demonstrated hypermetabolism at PET-CT. Conclusions: In this preliminary series, we did not observe hypermetabolic activity in relation to endometriosis using 18FDG PET-CT. This study’s most important limitation is the use of 18FDG as an isotopic tracer, which is not specific to endometrial tissue. Similar content being viewed by others

Laufer MR, Sanfilippo J, Rose G. Adolescent endometriosis: diagnosis and treatment approaches. J Pediatr Adolesc Gynecol. 2003 Jun;16(3 Suppl):S3–11. Giudice LC, Kao LC. Endometriosis. Lancet 2004 Nov 13–19;364(9447):1789–99. Kennedy S, Bergqvist A, Chapron C, D’Hooghe T, Dunselman G, Greb R, Hummelshoj L, Prentice A, Saridogan E; ESHRE Special Interest Group for Endometriosis and Endometrium Guideline Development Group. ESHRE guideline for diagnosis & treatment of endometriosis. Hum Reprod. 2005 Oct;20(10):2698–704. Mol BW, Bayram N, Lijmer JG, Wiegerinck MA, Bongers MY, van der Veen F, Bossuyt PM. The performance of CA-125 measurement in the detection of endometriosis: a meta-analysis. Fertil Steril. 1998 Dec;70(6):1101–8. Moore J, Copley S, Morris J, Lindsell D, Golding S, Kennedy S. A systematic review of the accuracy of ultrasound in the diagnosis of endometriosis. Ultrasound Obstet Gynecol. 2002 Dec;20(6):630–4. Bazot M, Lafont C, Rouzier R, Roseau G, Thomassin-Naggara I, Daraï E. Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis. Fertil Steril. 2009 Dec;92(6):1825–33. No authors listed. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril. 1997 May;67(5):817–21. Chapron C, Fauconnier A, Vieira M, Barakat H, Dousset B, Pansini V, Vacher-Lavenu MC, Dubuisson JB. Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification. Hum Reprod. 2003 Jan;18(1):157–61. D’Hooghe TM, Debrock S, Hill JA, Meuleman C. Endometriosis and subfertility: is the relationship resolved? Semin Reprod Med. 2003 May;21(2):243–54. Koninckx PR, Oosterlynck D, D’Hooghe T, Meuleman C. Deeply infiltrating endometriosis is a disease whereas mild endometriosis could be considered a non-disease. Ann N Y Acad Sci. 1994 Sep 30;734:333–41. Fenchel S, Grab D, Nuessle K, Kotzerke J, Rieber A, Kreienberg R, Brambs HJ, Reske SN. Asymptomatic adnexal masses: correlation of FDG PET and histologic findings. Radiology. 2002 Jun;223(3):780–8. Kirkpatrick A, Reed CM, Bui-Mansfield LT, Russell MJ, Whitford W. Radiologic-pathologic conference of Brooke Army Medical Center: endometriosis of the canal of Nuck. AJR Am J Roentgenol. 2006 Jan;186(1):56–7. Derman AY, Sperling D, Merav A, Jain VR, Levin M, Jana S, Haramati LB. Endometrioma presenting as a cavitary mass with intense 18F-FDG uptake on PET-CT. J thoracic Imaging. 2007 may; 22(2):172–5. Jeffry L, Kerrou K, Camatte S, Metzger U, Lelièvre L, Talbot JN, Lecuru F. Endometriosis with FDG upatake on PET. Eur J Obstet Gynecol Reprod Biol. 2004 Dec 1; 117(2):236–9. Beckers C, Ribbens C, André B, Marcelis S, Kaye O, Mathy L, Kaiser MJ, Hustinx R, Foidart J, Malaise MG. Assessment of disease activity in rheumatoid arthritis with (18)F-FDG PET. J Nucl Med. 2004 Jun;45(6):956–64. Henes JC, Müller M, Krieger J, Balletshofer B, Pfannenberg AC, Kanz L, Kötter I. [18F] FDG-PET/CT as a new and sensitive imaging method for the diagnosis of large vessel vasculitis. Clin Exp Rheumatol. 2008 May–Jun;26(3 Suppl 49):S47–52. Sumathi VP, McCluggage WG. CD10 is useful in demonstrating endometrial stroma at ectopic sites and in confirming a diagnosis of endometriosis. J Clin Pathol. 2002 May; 55(5):391–2. Dharan M. The adjunctive value of CD10 immunostaining on cell block preparations in pelvic endometriosis. Acta Cytol. 2009 Nov–Dec;53(6):625–9. Lapela M, Leskinen-Kallio S, Varpula M, Grénman S, Salmi T, Alanen K, Någren K, Lehikoinen P, Ruotsalainen U, Teräs M. Metabolic imaging of ovarian tumors with carbon-11-methionine: a PET study. J Nucl Med. 1995 Dec;36(12):2196–200. Holder WD Jr. White RL Jr. Zuger JH, Easton EJ Jr. Greene FL. Effectiveness of positron emission tomography for the detection of melanoma metastases. Ann Surg. 1998 May;227(5):764–9; discussion 769–71. Rieber A, Nüssle K, Stöhr I, Grab D, Fenchel S, Kreienberg R, Reske SN, Brambs HJ. Preoperative diagnosis of ovarian tumors with MR imaging: comparison with transvaginal sonography, positron emission tomography, and histologic findings. AJR Am J Roentgenol. 2001 Jul;177(1):123–9. Koninckx PR, Meuleman C, Demeyere S, Lesaffre E, Cornillie FJ. Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril. 1991 Apr; 55(4):759–65. Porpora MG, Koninckx PR, Piazze J, Natili M, Colagrande S, Cosmi EV. Correlation between endometriosis and pelvic pain. J Am Assoc Gynecol Laparosc. 1999 Nov;6(4):429–34. Chapron C, Fauconnier A, Dubuisson JB, Barakat H, Vieira M, Bréart G. Deep infiltrating endometriosis: relation between severity of dysmenorrhoea and extent of disease. Hum Reprod. 2003 Apr;18(4):760–6. Bourdel N, Durand M, Gimbergues P, Dauplat J, Canis M. Exclusive nodal recurrence after treatment of degenerated parietal endometriosis. Fertil Steril. 2010 Apr;93(6):2074.e1–6. Beauregard JM, Turcotte É, Bénard F. Steroid receptor imaging in breast cancer. PET Clinics. 2006 1:51–70. Beauregard JM, Croteau E, Ahmed N, van Lier JE, Bénard F. Assessment of human biodistribution and dosimetry of 4-fluoro-11beta-methoxy-16alpha-18F-fluoroestradiol using serial whole-body PET/CT. J Nucl Med. 2009 Jan;50(1):100–7. Author information Authors and Affiliations Corresponding author Additional information Author’s role M Fastrez was responsible of the patients recruitment, participated to laparoscopies, collected data and drafted the manuscript. C Nogarède analyzed all 18FDG PET — CT, with the help of M Tondeur. N Sirtaine analysed all tissue specimens. S Rozenberg participated to the design of the study and the writing of the manuscript. Rights and permissions About this article Cite this article Fastrez, M., Nogarède, C., Tondeur, M. et al. Evaluation of 18FDG PET-CT in the Diagnosis of Endometriosis: A Prospective Study. Reprod. Sci. 18, 540–544 (2011). https://doi.org/10.1177/1933719110392060 Published: Issue date: DOI: https://doi.org/10.1177/1933719110392060