Inubashiri Eisuke, Hata Kohkichi, Kanenishi Kenji, Shiota Atsuko, Ohno Masayuki, Yamamoto Yuka, Nishiyama Yoshihiro, Ohkawa Motoomi, Hata Toshiyuki
Department of Perinatology and Gynecology, Kagawa University School of Medicine, Miki, Kagawa, Japan.
J Obstet Gynaecol Res. 2009 Feb;35(1):26-34. doi: 10.1111/j.1447-0756.2008.00832.x.
The aims of this study were to investigate the ability of positron emission tomography (PET) with the glucose analog [(18)F]-fluoro-2-deoxy-D-glucose (FDG) to detect pelvic lymph node metastasis of uterine corpus cancer and to perform a retrospective comparison with computed tomography (CT) and magnetic resonance imaging (MRI) findings.
Forty-six patients with uterine corpus cancer scheduled for surgery, including bilateral pelvic and/or para-aortic lymphadenectomy, were eligible for this study. CT and MRI of the pelvis and abdomen were performed in all patients within 2 weeks preceding whole-body FDG-PET. FDG-PET images were analyzed visually for objective assessment of regional tracer uptake. The sensitivity and specificity of each imaging modality for detecting pelvic lymph node metastasis were determined, respectively.
Eleven (7 with myometrial invasion less than 1/2, 4 with myometrial invasion over 1/2) of the 46 patients (23.9%) were revealed to have pelvic lymph node metastasis. The sensitivity and specificity for detecting pelvic lymph node metastasis in patients with uterine corpus cancer by FDG-PET were 31.3% and 96.1% by lymph node region, respectively, and 36.4% and 91.4% by patient, respectively. No significant difference was noted among each imaging modality with sensitivity or specificity. Moreover, the sensitivity and specificity for detecting pelvic lymph node metastasis in 29 patients with endometrioid adenocarcinomas by FDG-PET were 28.6% and 96.1% by lymph node region, respectively, and 50% and 92% by patient, respectively. No significant difference was noted among each imaging modality in terms of sensitivity or specificity. Among 11 patients with pathologically positive pelvic lymph node metastasis, three out of four patients with myometrial invasion over 1/2 were diagnosed as pelvic lymph node metastasis positive by all diagnostic modalities, however, only one of seven patients with myometrial invasion less than 1/2 was diagnosed as pelvic lymph node metastasis positive by PDF-PET and CT. MRI could not detect pelvic lymph node metastasis in patients with myometrial invasion less than 1/2.
We suggest that current imaging modalities including FDG-PET cannot change medical management of patients with uterine corpus cancer before surgery.
本研究旨在探讨正电子发射断层扫描（PET）利用葡萄糖类似物[（18）F]-氟-2-脱氧-D-葡萄糖（FDG）检测子宫体癌盆腔淋巴结转移的能力，并与计算机断层扫描（CT）和磁共振成像（MRI）结果进行回顾性比较。
46例计划接受手术（包括双侧盆腔和/或腹主动脉旁淋巴结清扫术）的子宫体癌患者符合本研究条件。在全身FDG-PET检查前2周内，对所有患者进行盆腔和腹部的CT及MRI检查。对FDG-PET图像进行视觉分析，以客观评估局部示踪剂摄取情况。分别确定每种成像方式检测盆腔淋巴结转移的敏感性和特异性。
46例患者中有11例（23.9%）被发现有盆腔淋巴结转移（7例肌层浸润小于1/2，4例肌层浸润超过1/2）。FDG-PET检测子宫体癌患者盆腔淋巴结转移的敏感性和特异性，按淋巴结区域分别为31.3%和96.1%，按患者分别为36.4%和91.4%。各成像方式在敏感性或特异性方面未发现显著差异。此外，FDG-PET检测29例子宫内膜样腺癌患者盆腔淋巴结转移的敏感性和特异性，按淋巴结区域分别为28.6%和96.1%，按患者分别为50%和92%。各成像方式在敏感性或特异性方面未发现显著差异。在11例病理检查盆腔淋巴结转移阳性的患者中，4例肌层浸润超过1/2的患者中有3例被所有诊断方式诊断为盆腔淋巴结转移阳性，然而，7例肌层浸润小于1/2的患者中只有1例被FDG-PET和CT诊断为盆腔淋巴结转移阳性。MRI未能检测出肌层浸润小于1/2患者的盆腔淋巴结转移。
我们认为，目前包括FDG-PET在内的成像方式在术前无法改变子宫体癌患者的治疗方案。
