From the *Service of Nuclear Medicine, Sant' Orsola-Malpighi Hospital, Bologna, Italy; †Section of Nuclear Medicine, Instituto Nacional do Câncer, Rio de Janeiro, Brazil; ‡Servicio de Medicina Nuclear, Hospital Clinico San Carlos, Madrid, Spain; §Department of Urology, Sant'Orsola-Malpighi Hospital, Bologna; and ∥Department of Nuclear Medicine & PET/CT Centre, Santa Maria della Misericordia Hospital, Rovigo, Italy; and ¶Department of Radiology, University of Southern California School of Medicine, Los Angeles, CA.
Clin Nucl Med. 2015 Jan;40(1):e1-5. doi: 10.1097/RLU.0000000000000573.
The aim of this study was to evaluate of C-choline PET/CT in bladder cancer (BC) patients with suspected relapse after primary therapy.
Twenty-five BC patients with surgery (21 [84%]) or radiotherapy (4 [16%]) with curative intent had PET/CT for suspicion of relapse. Mean TNM was T2b N0 M0 (range, T1a N0 M0 to T4 N2 M0), whereas mean age was 71.3 years (range, 50-85 years). Nine (36%) of 25 were treated with adjuvant or salvage chemotherapy within 6 months before PET/CT. Positive findings were validated by histology or correlative imaging and/or clinical follow-up lasting at least 12 months. Age, TNM, histology, previous chemotherapy, and type of primary treatment were correlated with PET/CT positivity by univariate and multivariate binary logistic regression analysis.
C-choline PET/CT was positive in 16 (64%) of 25. Six (37.5%) of 16 were positive in residual bladder/bladder bed, with 2 local false positive (FP) and 1 false negative (FN) on lymph nodes (LNs); 3 of 16 patients had PET-positive LNs with 1 FP; 1 of 16 patients showed distant metastases. Two (12.5%) of 16 had positive residual bladder/bladder bed and locoregional LNs; 1 (6.3%) of 16, residual bladder/bladder bed and bone; metastasis, 1 (6.3%) of 16 residual bladder/bladder bed and lung metastasis; 2 (12.5%) of 16, LN and distant metastasis. Five (56%) of 9 of PET negatives were FN in residual bladder/bladder bed. Eighteen (72%) of 25 were validated by histology, with 7 (18%) of 25 by correlative imaging and/or clinical follow-up. C-choline PET/CT was sensitive, specific, and accurate, with good positive and negative predictive values for local relapse of 66.7%, 84.6%, 76%, 80%, and 73.3% and 90%, 93.3%, 92%, 90%, and 93.3% for LNs and distant relapse, respectively. No FP or FN was detected for distant metastasis. None of the investigated factors were statistically significant.
C-choline PET/CT is useful for restaging BC suspected of relapse, especially for the evaluation of LN or distant metastases.
本研究旨在评估胆碱 C-PET/CT 在疑似原发性治疗后复发的膀胱癌（BC）患者中的作用。
25 例接受根治性手术（21 例[84%]）或放疗（4 例[16%]）的 BC 患者因疑似复发而接受 PET/CT 检查。平均 TNM 为 T2b N0 M0（范围，T1a N0 M0 至 T4 N2 M0），平均年龄为 71.3 岁（范围，50-85 岁）。9 例（36%）患者在 PET/CT 检查前 6 个月内接受了辅助或挽救性化疗。阳性发现通过组织学或相关影像学和/或至少 12 个月的临床随访得到验证。通过单因素和多因素二元逻辑回归分析，将年龄、TNM、组织学、既往化疗和原发性治疗类型与 PET/CT 阳性结果相关联。
25 例患者中，胆碱 C-PET/CT 阳性 16 例（64%）。16 例中有 6 例（37.5%）在残留膀胱/膀胱床中呈阳性，其中 2 例为局部假阳性（FP）和 1 例假阴性（FN）淋巴结（LN）；16 例患者中有 3 例 PET 阳性 LN，其中 1 例为 FP；16 例患者中有 1 例出现远处转移。2 例（12.5%）患者有阳性残留膀胱/膀胱床和局部 LN；1 例（6.3%）患者有残留膀胱/膀胱床和骨转移；1 例（6.3%）患者有远处转移，1 例（6.3%）患者有远处转移。9 例 PET 阴性中有 5 例（56%）为残留膀胱/膀胱床假阴性。18 例（72%）患者经组织学证实，18 例（72%）患者经相关影像学和/或临床随访证实。胆碱 C-PET/CT 对局部复发的敏感性、特异性和准确性较高，阳性预测值和阴性预测值分别为 66.7%、84.6%、76%、80%和 73.3%，对 LN 和远处复发的敏感性、特异性和准确性分别为 90%、93.3%、92%、90%和 93.3%。未检测到远处转移的 FP 或 FN。未发现有统计学意义的调查因素。
胆碱 C-PET/CT 对疑似复发的膀胱癌患者的再分期有用，特别是对评估 LN 或远处转移。
