纳米颗粒增强磁共振成像在子宫内膜癌和宫颈癌患者淋巴结转移诊断中的诊断性能

Diagnostic performance of nanoparticle-enhanced magnetic resonance imaging in the diagnosis of lymph node metastases in patients with endometrial and cervical cancer.

作者信息

Rockall Andrea G, Sohaib Syed A, Harisinghani Mukesh G, Babar Syed A, Singh Naveena, Jeyarajah Arjun R, Oram David H, Jacobs Ian J, Shepherd John H, Reznek Rodney H

机构信息

FRCR, Department of Radiology, Dominion House, St Bartholomew's Hospital, W Smithfield, London EC1A 7ED, United Kingdom.

出版信息

J Clin Oncol. 2005 Apr 20;23(12):2813-21. doi: 10.1200/JCO.2005.07.166.

DOI:10.1200/JCO.2005.07.166

PMID:15837995

Abstract

PURPOSE

Lymph node metastases affect management and prognosis of patients with gynecologic malignancies. Preoperative nodal assessment with computed tomography or magnetic resonance imaging (MRI) is inaccurate. A new lymph node-specific contrast agent, ferumoxtran-10, composed of ultrasmall particles of iron oxide (USPIO), may enhance the detection of lymph node metastases independent of node size. Our aim was to compare the diagnostic performance of MRI with USPIO against standard size criteria.

METHODS

Forty-four patients with endometrial (n = 15) or cervical (n = 29) cancer were included. MRI was performed before and after administration of USPIO. Two independent observers viewed the MR images before lymph node sampling. Lymph node metastases were predicted using size criteria and USPIO criteria. Lymph node sampling was performed in all patients.

RESULTS

Lymph node sampling provided 768 pelvic or para-aortic nodes for pathology, of which 335 were correlated on MRI; 17 malignant nodes were found in 11 of 44 patients (25%). On a node-by-node basis, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) by size criteria were 29%, 99%, 56%, and 96%, and by USPIO criteria (reader 1/reader 2) were 93%/82% (P = .008/.004), 97%/97%, 61%/59%, and 100%/99%, respectively (where [] indicates the statistical difference of P = x/x between the two results marked by the asterisk). On a patient-by-patient basis, sensitivity, specificity, PPV, and NPV by size criteria were 27%, 94%, 60%, and 79%, and by USPIO criteria (reader 1/reader 2) were 100%/91% (*P = .031/.06), 94%/87%, 82%/71%, and 100%/96%, respectively. The kappa statistic was 0.93.

CONCLUSION

Lymph node characterization with USPIO increases the sensitivity of MRI in the prediction of lymph node metastases, with no loss of specificity. This may greatly improve preoperative treatment planning.

摘要

目的

淋巴结转移影响妇科恶性肿瘤患者的治疗和预后。术前通过计算机断层扫描或磁共振成像（MRI）进行淋巴结评估并不准确。一种新型的淋巴结特异性造影剂，即由超小氧化铁颗粒（USPIO）组成的ferumoxtran - 10，可能会提高对淋巴结转移的检测能力，且不受淋巴结大小的影响。我们的目的是比较使用USPIO的MRI与标准大小标准的诊断性能。

方法

纳入44例子宫内膜癌（n = 15）或宫颈癌（n = 29）患者。在注射USPIO前后进行MRI检查。两名独立观察者在淋巴结取样前查看MR图像。使用大小标准和USPIO标准预测淋巴结转移。所有患者均进行淋巴结取样。

结果

淋巴结取样提供了768个盆腔或腹主动脉旁淋巴结用于病理检查，其中335个在MRI上有对应；44例患者中有11例（25%）发现17个恶性淋巴结。在逐个淋巴结的基础上，根据大小标准的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为29%、99%、56%和96%，根据USPIO标准（观察者1/观察者2）分别为93%/82%（P = 0.008/0.004）、97%/97%、61%/59%和100%/99%（其中[]表示两个带星号结果之间P = x/x的统计学差异）。在逐个患者的基础上，根据大小标准的敏感性、特异性、PPV和NPV分别为27%、94%、60%和79%，根据USPIO标准（观察者1/观察者2）分别为100%/91%（*P = 0.031/0.06）、94%/87%、82%/71%和100%/96%。kappa统计量为0.93。