Schaefferkoetter Joshua D, Carlson Eric R, Heidel Robert E
Postdoctoral Research Fellow, Agency for Science, Technology, and Research, National University of Singapore, Singapore.
Professor and Kelly L. Krahwinkel Chairman, Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center and University of Tennessee Cancer Institute, Knoxville, TN.
J Oral Maxillofac Surg. 2015 Jul;73(7):1420-8. doi: 10.1016/j.joms.2015.01.002. Epub 2015 Jan 13.
The present study investigated the performance of cellular metabolism imaging with 2-deoxy-2-((18)F) fluoro-D-glucose (FDG) versus cellular proliferation imaging with 3'-deoxy-3'-((18)F) fluorothymidine (FLT) in the detection of cervical lymph node metastases in oral/head and neck cancer.
We conducted a prospective cohort study to assess a head-to-head performance of FLT imaging and clinical FDG imaging for characterizing cervical lymph node metastases in patients with squamous cell carcinoma (SCC) of the oral/head and neck region. The primary predictor variable of the study was the presence of FDG or FLT avidity within the cervical lymph nodes. The primary outcome variable was the histologic presence of metastatic SCC in the cervical lymph nodes. The performance was reported in terms of the sensitivity, specificity, accuracy, and positive and negative predictive values. The overall accuracy for discriminating positive from negative lymph nodes was evaluated as a function of the positron emission tomography (PET) standardized uptake value (SUV). Receiver operating characteristic (ROC) analyses were performed for both tracers.
Eleven patients undergoing surgical resection of SCC of the oral/head and neck region underwent preoperative FDG and FLT PET-computed tomography (CT) scans on separate days. The interpretation of the FDG PET-CT imaging resulted in sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 43.2, 99.5, 94.4, 88.9, and 94.7%, respectively. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for FLT PET-CT imaging was 75.7, 99.2, 97.1, 90.3, and 97.7%, respectively. The areas under the curve for the ROC curves were 0.9 and 0.84 for FDG and FLT, respectively. Poor correlation was observed between the SUV for FDG and FLT within the lymph nodes and tumors.
FLT showed better overall performance for detecting lymphadenopathy on qualitative assessment within the total nodal population. This notwithstanding, FDG SUV performed better for pathologic discrimination within the visible lymph nodes.
本研究调查了用2-脱氧-2-（（18）F）氟-D-葡萄糖（FDG）进行细胞代谢成像与用3'-脱氧-3'-（（18）F）氟胸苷（FLT）进行细胞增殖成像在检测口腔/头颈部癌颈部淋巴结转移方面的性能。
我们进行了一项前瞻性队列研究，以评估FLT成像与临床FDG成像在表征口腔/头颈部区域鳞状细胞癌（SCC）患者颈部淋巴结转移方面的直接对比性能。该研究的主要预测变量是颈部淋巴结内FDG或FLT的摄取情况。主要结局变量是颈部淋巴结中转移性SCC的组织学存在情况。性能以敏感性、特异性、准确性以及阳性和阴性预测值来报告。将区分阳性和阴性淋巴结的总体准确性评估为正电子发射断层扫描（PET）标准化摄取值（SUV）的函数。对两种示踪剂均进行了受试者操作特征（ROC）分析。
11例接受口腔/头颈部区域SCC手术切除的患者在不同日期分别接受了术前FDG和FLT PET计算机断层扫描（CT）。FDG PET-CT成像的解释结果显示，敏感性、特异性、准确性、阳性预测值和阴性预测值分别为43.2%、99.5%、94.4%、88.9%和94.7%。FLT PET-CT成像的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为75.7%、99.2%、97.1%、90.3%和97.7%。FDG和FLT的ROC曲线下面积分别为0.9和0.84。在淋巴结和肿瘤内，FDG和FLT的SUV之间观察到较差的相关性。
在对整个淋巴结群体进行定性评估时，FLT在检测淋巴结病方面显示出更好的总体性能。尽管如此，FDG SUV在可见淋巴结的病理鉴别方面表现更好。
