Park Jeong-Yeol, Kim Eyu Nyong, Kim Dae-Yeon, Suh Dae-Shik, Kim Jong-Hyeok, Kim Yong-Man, Kim Young-Tak, Nam Joo-Hyun
Obstetrics and Gynecology, College of Medicine, University of Ulsan, Asan Medical Center, #388-1 Poongnap-dong, Songpa-Ku, Seoul, 138-736, South Korea.
Gynecol Oncol. 2008 Mar;108(3):486-92. doi: 10.1016/j.ygyno.2007.11.044. Epub 2008 Jan 16.
To compare positron emission tomography/computed tomography (PET/CT) with magnetic resonance imaging (MRI) in the preoperative detection of primary lesions and lymph node (LN) and distant metastases in patients with uterine corpus cancer.
The patient cohort consisted of 53 women with uterine corpus cancer who underwent preoperative workup, including both MRI and PET/CT scans, and underwent surgical staging, including pelvic and/or paraaortic LN dissection, between October 2004 and June 2007 at Asan Medical Center, Seoul, Korea. Pathologic data from surgical staging were compared with the preoperative MRI and PET/CT results. For area specific analysis, LNs were divided into paraaortic, right pelvic and left pelvic areas.
In detecting primary lesions, MRI and PET/CT showed no differences in sensitivity (91.5% vs. 89.4%), specificity (33.3% vs. 50.5%), accuracy (84.9% vs. 84.9%), positive predictive value (PPV) (91.5% vs. 93.3%) and negative predictive value (NPV) (33.3% vs. 37.5%). With MRI, the sensitivity, specificity, accuracy, PPV and NPV for detecting metastatic LNs on LN area-by-area analysis were 46.2%, 87.9%, 83.9%, 28.6% and 94.0%, respectively; With PET/CT, those were 69.2%, 90.3%, 88.3%, 42.9%, and 96.6%, respectively. PET/CT showed higher sensitivity, but it did not reach statistical significance (p=0.250). There were also no differences in specificity, accuracy, PPV and NPV. In detecting distant metastasis, the sensitivity, specificity, accuracy, PPV and NPV of PET/CT were 100%, 93.8%, 92.5%, 62.5% and 100%, respectively.
In patients with uterine corpus cancer, PET/CT had moderate sensitivity, specificity and accuracy in detecting primary lesions and LN metastases, indicating that this method cannot replace surgical staging. The primary benefit of PET/CT is its sensitivity in detecting distant metastases. Because of its high NPV in predicting LN metastasis, PET/CT may also have advantages in selected patients who are poor candidates for surgical staging.
比较正电子发射断层扫描/计算机断层扫描（PET/CT）与磁共振成像（MRI）在子宫体癌患者术前检测原发灶、淋巴结（LN）及远处转移方面的效果。
研究队列包括53例子宫体癌女性患者，于2004年10月至2007年6月在韩国首尔峨山医学中心接受了术前检查，包括MRI和PET/CT扫描，并接受了手术分期，包括盆腔和/或腹主动脉旁LN清扫。将手术分期的病理数据与术前MRI和PET/CT结果进行比较。为进行区域特异性分析，将LN分为腹主动脉旁、右盆腔和左盆腔区域。
在检测原发灶方面，MRI和PET/CT在敏感性（91.5%对89.4%）、特异性（33.3%对50.5%）、准确性（84.9%对84.9%）、阳性预测值（PPV）（91.5%对93.3%）和阴性预测值（NPV）（33.3%对37.5%）方面无差异。对于MRI，在按LN区域逐个分析中检测转移LN的敏感性、特异性、准确性、PPV和NPV分别为46.2%、87.9%、83.9%、28.6%和94.0%；对于PET/CT，分别为69.2%、90.3%、88.3%、42.9%和96.6%。PET/CT显示出更高的敏感性，但未达到统计学意义（p=0.250）。在特异性、准确性、PPV和NPV方面也无差异。在检测远处转移方面，PET/CT的敏感性、特异性、准确性、PPV和NPV分别为100%、93.8%、92.5%、62.5%和100%。
在子宫体癌患者中，PET/CT在检测原发灶和LN转移方面具有中等的敏感性、特异性和准确性，表明该方法不能替代手术分期。PET/CT的主要优势在于其检测远处转移的敏感性。由于其在预测LN转移方面具有较高的NPV，PET/CT在某些不适合手术分期的特定患者中可能也具有优势。
