Department of Obstetrics and Gynecology, University of Milan-Bicocca, Milan, Italy.
Gynecol Oncol. 2011 Nov;123(2):236-40. doi: 10.1016/j.ygyno.2011.07.096. Epub 2011 Aug 19.
Nodal status is one of the most important findings in patients with early-stage cervical cancer that requires post-surgical adjuvant therapies and influences prognosis of patients. The purpose of this study was to determine the diagnostic accuracy of 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG-PET/CT) in the detection of nodal metastases.
From 2004 to 2010 women with Ib1-IIa <4cm cervical cancer underwent 18F-FDG-PET/CT followed by radical hysterectomy and pelvic lymphadenectomy in our institution. 18F-FDG-PET/CT images were analyzed and histopathological findings served as the reference standard. Diagnostic performance of 18F-FDG-PET/CT in nodal disease detection was reported in terms of accuracy value. A sub analysis of women with tumor diameter <2cm (group 1) or 2-4cm (group 2) was performed in order to verify the efficacy of 18F-FDG-PET/CT in each group.
One hundred fifty-nine women were enrolled. 65% had squamous histotype and 51% had grade 3 disease. Median number of nodes dissected was 29 (range 11-61). 28/159 women (18%) showed nodal metastases. Overall patient-based sensitivity, specificity, positive and negative predictive value of 18F-FDG-PET/CT for detection of nodal disease were 32.1%, 96.9%, 69.2%and 87.0% respectively. Among the 97 (61%) women included in group 1, 8 had nodal metastases (8.2%) and 2 was discovered through 18F-FDG-PET/CT (25%), while 20/62 women of the group 2 (32.3%) had nodal involvement, of which 7 (35%) was detected by 18F-FDG-PET/CT.
This study showed that 18F-FDG-PET/CT had low sensitivity and had a minimal clinical impact in the pretreatment planning of stage Ib1-IIa <4cm cervical cancer.
淋巴结状态是早期宫颈癌患者最重要的发现之一，需要术后辅助治疗，并影响患者的预后。本研究旨在确定 18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（18F-FDG-PET/CT）在检测淋巴结转移中的诊断准确性。
2004 年至 2010 年，我院对 Ib1-IIa<4cm 的宫颈癌患者进行了 18F-FDG-PET/CT 检查，随后进行根治性子宫切除术和盆腔淋巴结切除术。分析 18F-FDG-PET/CT 图像，并以组织病理学检查结果为参考标准。报告 18F-FDG-PET/CT 在淋巴结疾病检测中的诊断性能，以准确性值表示。对肿瘤直径<2cm（组 1）或 2-4cm（组 2）的患者进行亚组分析，以验证 18F-FDG-PET/CT 在每组中的疗效。
共纳入 159 例患者。51%为 3 级病变，65%为鳞状组织学类型。中位数淋巴结清扫数为 29 个（范围 11-61 个）。159 例患者中有 28 例（18%）出现淋巴结转移。18F-FDG-PET/CT 对检测淋巴结疾病的总体患者敏感性、特异性、阳性预测值和阴性预测值分别为 32.1%、96.9%、69.2%和 87.0%。在纳入组 1 的 97 例（61%）患者中，8 例（8.2%）有淋巴结转移，2 例（25%）通过 18F-FDG-PET/CT 发现，而组 2 的 62 例（32.3%）患者中有 20 例（32.3%）有淋巴结受累，其中 7 例（35%）通过 18F-FDG-PET/CT 发现。
本研究表明，18F-FDG-PET/CT 在 Ib1-IIa<4cm 宫颈癌的术前治疗计划中敏感性低，临床影响有限。
