Sironi Sandro, Messa Cristina, Mangili Giorgia, Zangheri Barbara, Aletti Giovanni, Garavaglia Elisabetta, Vigano Riccardo, Picchio Maria, Taccagni Gianluca, Maschio Alessandro Del, Fazio Ferruccio
School of Medicine, University of Milano-Bicocca, Milan, Italy; Institute for Molecular Imaging and Physiology of the National Research Council of Italy, Milan.
Radiology. 2004 Nov;233(2):433-40. doi: 10.1148/radiol.2332031800.
To prospectively evaluate the accuracy of integrated positron emission tomography (PET) and computed tomography (CT) for depiction of persistent ovarian carcinoma after first-line treatment, with use of histologic findings as the reference standard.
Thirty-one women (mean age, 55.9 years) with ovarian carcinoma treated with primary cytoreductive surgery and followed up with platinum regimen chemotherapy were included. All 31 patients were scheduled for surgical second-look. Before surgical second-look, all patients underwent fluorodeoxyglucose (FDG) PET/CT. At PET/CT, three main categories of persistent disease were considered for data analysis: lymph nodal lesion, peritoneal lesion, and pelvic lesion. In all patients, imaging findings were compared with results of histologic examination after surgical second-look to determine the diagnostic accuracy of PET/CT in the evaluation of disease status. The kappa statistic (Cohen kappa) was used for statistical analysis.
Seventeen (55%) of 31 patients had persistent tumor at histologic analysis after surgical second-look, and fourteen (45%) had no histologically proved tumor. The total number of lesions that was positive for tumor cells at histologic analysis was 41 (lymph nodes, n = 16; peritoneal lesions, n = 21; pelvic lesions, n = 4); maximum diameter of these lesions was 0.3-3.2 cm (mean, 1.7 cm). A correlation was found between PET/CT and histologic analysis (kappa = 0.48). The overall lesion-based sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of PET/CT were 78%, 75%, 77%, 89% and 57%, respectively. In the detection of a tumor, a size threshold could be set at 0.5 cm, as this was the largest diameter of a lesion missed at PET/CT.
Integrated PET/CT depicts persistent ovarian carcinoma with a high positive predictive value.
以前瞻性方式评估正电子发射断层显像（PET）与计算机断层扫描（CT）融合成像用于描绘一线治疗后持续性卵巢癌的准确性，并将组织学检查结果作为参考标准。
纳入31例卵巢癌女性患者（平均年龄55.9岁），这些患者接受了初次肿瘤细胞减灭术，并接受铂类方案化疗随访。所有31例患者均计划接受二次手术探查。在二次手术探查前，所有患者均接受氟脱氧葡萄糖（FDG）PET/CT检查。在PET/CT检查中，数据分析时考虑了三类主要的持续性疾病：淋巴结病变、腹膜病变和盆腔病变。在所有患者中，将成像结果与二次手术探查后的组织学检查结果进行比较，以确定PET/CT在评估疾病状态中的诊断准确性。采用kappa统计量（科恩kappa系数）进行统计分析。
31例患者中，17例（55%）在二次手术探查后的组织学分析中存在持续性肿瘤，14例（45%）未发现组织学证实的肿瘤。组织学分析中肿瘤细胞阳性的病变总数为41个（淋巴结，n = 16；腹膜病变，n = 21；盆腔病变，n = 4）；这些病变的最大直径为0.3 - 3.2 cm（平均1.7 cm）。发现PET/CT与组织学分析之间存在相关性（kappa = 0.48）。基于病变的PET/CT总体敏感性、特异性、准确性、阳性预测值和阴性预测值分别为78%、75%、77%、89%和57%。在检测肿瘤时，可以将大小阈值设定为0.5 cm，因为这是PET/CT遗漏的最大病变直径。
PET/CT融合成像对持续性卵巢癌具有较高的阳性预测值。
