18F-FDG PET与CT-MRI在已确诊或疑似复发性宫颈癌中的比较优势与局限性

Comparative benefits and limitations of 18F-FDG PET and CT-MRI in documented or suspected recurrent cervical cancer.

作者信息

Yen Tzu-Chen, Lai Chyong-Huey, Ma Shih-Ya, Huang Kuan-Gen, Huang Huei-Jean, Hong Ji-Hong, Hsueh Swei, Lin Wuu-Jyh, Ng Koon-Kwan, Chang Ting-Chang

机构信息

Department of Nuclear Medicine and Molecular Image Center, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University Medical College, Taoyuan, Taiwan.

出版信息

Eur J Nucl Med Mol Imaging. 2006 Dec;33(12):1399-407. doi: 10.1007/s00259-006-0090-x. Epub 2006 Jul 18.

DOI:10.1007/s00259-006-0090-x

PMID:16847653

Abstract

PURPOSE

The purpose of this study was to assess the comparative benefits and limitations of (18)F-fluorodeoxyglucose (FDG) PET and CT-MRI in documented or suspected recurrence of cervical cancer after primary treatment.

METHODS

Three patient groups were enrolled. Group A patients had biopsy-documented recurrent or persistent cervical cancer. Group B patients had suspicion of recurrent tumour on CT-MRI without biopsy proof and were potentially curable. Group C patients were in complete remission after previous definitive treatment for histologically confirmed cervical carcinoma but had elevated serum squamous cell carcinoma antigen (tumour marker) levels despite negative CT-MRI. Clinical management decisions were recorded with CT-MRI alone and with additional FDG PET. Discordances and concordances between CT-MRI and FDG PET results were identified and related to final diagnosis as based on histopathology or follow-up.

RESULTS

A total of 150 patients (ten regions per patient) were eligible for analysis, with 58 in group A, 52 in group B and 40 in group C. For the 149 discordant regions, 126 (84.6%) had final diagnoses. Of these final diagnoses, there was additional benefit from FDG PET over CT-MRI in 73.8% (93/126), with FDG PET correcting false negatives (FNs) on CT-MRI in 74.2% (69/93) and correcting false positives (FPs) on CT-MRI in 25.8% (24/93). Among lesions confirmed by FDG PET, 75.4% (52/69) were extra-pelvic. There was additional benefit of CT-MRI compared with FDG PET in 26.2% (33/126): in nine (27.3%) CT-MRI results were shown to be true positive (TP) whereas FDG PET yielded FN results, while in 24 (72.7%) CT-MRI corrected FP results on FDG PET. Among the nine FNs on FDG PET that were identified by CT-MRI, four were extra-pelvic. Among the FPs on FDG PET that were excluded by CT-MRI, 79.2% (19/24) were extra-pelvic.

CONCLUSION

For recurrent cervical cancer, the benefits of FDG PET exceed those of CT-MRI owing to the ability of FDG PET to identify extra-pelvic metastases and its higher sensitivity and specificity.

摘要

目的

本研究旨在评估¹⁸F-氟脱氧葡萄糖（FDG）PET与CT-MRI在宫颈癌初次治疗后已证实或疑似复发中的比较优势和局限性。

方法

纳入三组患者。A组患者经活检证实为复发性或持续性宫颈癌。B组患者经CT-MRI怀疑有肿瘤复发但未经活检证实，且有可能治愈。C组患者在先前对组织学确诊的宫颈癌进行确定性治疗后完全缓解，但尽管CT-MRI结果为阴性，血清鳞状细胞癌抗原（肿瘤标志物）水平却升高。记录仅采用CT-MRI以及联合FDG PET时的临床管理决策。确定CT-MRI与FDG PET结果之间的不一致和一致情况，并将其与基于组织病理学或随访的最终诊断相关联。

结果

共有150例患者（每位患者10个区域）符合分析条件，其中A组58例，B组52例，C组40例。对于149个不一致区域，126个（84.6%）有最终诊断结果。在这些最终诊断中，FDG PET相对于CT-MRI有额外益处的占73.8%（93/126），其中FDG PET纠正了CT-MRI上74.2%（69/93）的假阴性（FN）结果，纠正了CT-MRI上25.8%（24/93）的假阳性（FP）结果。在FDG PET证实的病变中，75.4%（52/69）为盆腔外病变。CT-MRI相对于FDG PET有额外益处的占26.2%（33/126）：其中9个（27.3%）CT-MRI结果显示为真阳性（TP），而FDG PET得出FN结果；在24个（72.7%）中，CT-MRI纠正了FDG PET上的FP结果。在CT-MRI发现的FDG PET的9个FN中，4个为盆腔外病变。在CT-MRI排除的FDG PET的FP中，79.2%（19/24）为盆腔外病变。