[11C]胆碱正电子发射断层扫描/计算机断层扫描与常规计算机断层扫描在膀胱癌根治性膀胱切除术前淋巴结分期中的诊断效能比较。

Diagnostic efficacy of [11C]choline positron emission tomography/computed tomography compared with conventional computed tomography in lymph node staging of patients with bladder cancer prior to radical cystectomy.

机构信息

Department of Urology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.

出版信息

Eur Urol. 2012 May;61(5):1031-8. doi: 10.1016/j.eururo.2011.12.009. Epub 2011 Dec 14.

DOI:10.1016/j.eururo.2011.12.009

PMID:22196847

Abstract

BACKGROUND

Current imaging techniques are of limited value for lymph node (LN) staging in bladder cancer (BCa) patients scheduled for radical cystectomy (RC).

OBJECTIVE

Evaluate the diagnostic efficacy of [11C]choline positron emission tomography in combination with computed tomography (PET/CT) for LN staging of patients with BCa scheduled for RC and compare that efficacy with the diagnostic efficacy of CT and the gold standard of histopathologic evaluation.

DESIGN, SETTING, AND PARTICIPANTS: From June 2004 to May 2007, 44 patients with localized BCa were staged with [11C]choline PET with low-dose CT for attenuation correction and simultaneous intravenous and rectal contrast-enhanced diagnostic CT before RC and pelvic lymph node dissection (PLND). LNs were dissected from the internal and external iliac arteries up to the origin of the inferior mesentery artery according to a template with 14 predefined anatomic fields.

INTERVENTION

Diagnostic [11C]choline PET/CT before RC and regional LN dissection.

MEASUREMENTS

Histopathologic findings of resected LN were correlated with the results of [11C]choline PET/CT and CT alone in a patient- and field-based manner. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of [11C]choline PET/CT and CT were assessed.

RESULTS AND LIMITATIONS

LN metastases were found in 12 of 44 patients (27%). On patient-based analysis, sensitivity, specificity, PPV, NPV, and accuracy for [11C]choline PET/CT were calculated as 58%, 66%, 39%, 81%, and 64%, respectively; and for CT the calculated percentages were 75%, 56%, 39%, 86%, and 61%, respectively. Twenty-five of 471 dissected LN fields (5%) showed metastases. On field-based analysis, sensitivity, specificity, PPV, NPV, and accuracy for [11C]choline PET/CT were 28%, 95%, 21%, 96%, and 91%, respectively; for CT, the calculated percentages were 39%, 92%, 20%, 96%, and 90%, respectively. Limitations of this study are small patient number and the fact that not all patients underwent extensive PLND.

CONCLUSIONS

In patients with BCa who were scheduled for RC, preoperative LN staging with [11C]choline PET/CT was not able to improve diagnostic efficacy compared with conventional CT alone.

摘要

背景

目前的成像技术在膀胱癌（BCa）患者接受根治性膀胱切除术（RC）前的淋巴结（LN）分期方面价值有限。

目的

评估[11C]胆碱正电子发射断层扫描（PET）联合计算机断层扫描（CT）对接受 RC 治疗的 BCa 患者进行 LN 分期的诊断效能，并将其与 CT 及组织病理学评估金标准的诊断效能进行比较。

设计、地点和参与者：2004 年 6 月至 2007 年 5 月，44 例局限性 BCa 患者在 RC 前接受[11C]胆碱 PET 检查，低剂量 CT 用于衰减校正，同时进行静脉和直肠对比增强诊断 CT，随后进行盆腔淋巴结清扫术（PLND）。根据模板对从髂内动脉到肠系膜下动脉起始处的 14 个解剖预定义区域的 LN 进行解剖。

干预措施

RC 前进行[11C]胆碱 PET/CT 检查和区域性 LN 解剖。

测量方法

以患者和解剖区域为基础，将切除 LN 的组织病理学发现与[11C]胆碱 PET/CT 和 CT 单独检查的结果进行相关性分析。评估[11C]胆碱 PET/CT 和 CT 的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性。

结果和局限性

44 例患者中有 12 例（27%）发现 LN 转移。基于患者的分析，[11C]胆碱 PET/CT 的敏感性、特异性、PPV、NPV 和准确性分别为 58%、66%、39%、81%和 64%，而 CT 的相应百分比为 75%、56%、39%、86%和 61%。471 个解剖 LN 区域中有 25 个（5%）发现转移。基于解剖区域的分析，[11C]胆碱 PET/CT 的敏感性、特异性、PPV、NPV 和准确性分别为 28%、95%、21%、96%和 91%，而 CT 的相应百分比为 39%、92%、20%、96%和 90%。本研究的局限性在于患者数量较少，并非所有患者均接受广泛的 PLND。