Brar H, May T, Tau N, Langer D, MacCrostie P, Han K, Metser U
Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada; Princess Margaret Hospital, University of Toronto, Toronto, Canada.
Princess Margaret Hospital, University of Toronto, Toronto, Canada; Department of Medical Imaging, University of Toronto, Toronto, Canada.
Clin Radiol. 2017 Apr;72(4):302-306. doi: 10.1016/j.crad.2016.12.009. Epub 2017 Jan 17.
To compare the detection rate of extra-regional metastases in patients with recurrent gynaecological malignancies being considered for radical salvage surgery with combined 2-[F]-fluoro-2-deoxy-d-glucose (F-FDG) positron-emission tomography (PET)/computed tomography (CT) compared to conventional imaging.
A retrospective review was performed of all patients in a provincial database with recurrent gynaecological malignancies being considered for pelvic exenteration that underwent restaging with CT/PET between March 2011 and October 2014. Findings on PET and conventional imaging (CT±pelvic MRI) were abstracted. Disease sites were classified according to the location (regional nodal metastases, extra-regional nodal metastases, peritoneum, or other distant sites) and diagnostic certainty (definitive or equivocal). The proportion of patients positive for extra-regional recurrence was calculated for PET and conventional imaging. In addition, the proportion of patients with indeterminate lesions only was calculated for each modality and the sites of indeterminate findings were tabulated.
There were 85 patients (median age, 50 years; range: 30-81 years) with carcinoma of cervix (n=51), endometrium (n=18), vagina (n=6), or vulva (n=10). Extra-regional recurrence was detected in 8/85 (9.4%) and 24/85 (28.2%) patients on conventional imaging and PET, respectively (p=0.0017). The greatest impact of PET compared to conventional imaging was in the detection of extra-regional nodal metastases. PET had significantly fewer examinations equivocal for extra-regional recurrence versus conventional imaging (6/85 [7.1%] and 38/85 [44.7%], respectively, p<0.001).
In patients with recurrent gynaecological malignancies being considered for radical salvage surgery, PET may identify significantly more extra-regional recurrence than conventional imaging. PET may also result in fewer equivocal lesions. The impact of these results on patient management and outcome should be confirmed in future prospective trials.
比较联合使用2-[F]-氟-2-脱氧-D-葡萄糖（F-FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）与传统成像技术，对考虑行根治性挽救手术的复发性妇科恶性肿瘤患者区域外转移灶的检出率。
对省级数据库中2011年3月至2014年10月间所有考虑行盆腔脏器清除术的复发性妇科恶性肿瘤患者进行回顾性研究，这些患者均接受了CT/PET再分期检查。提取PET和传统成像（CT±盆腔MRI）的检查结果。根据病变部位（区域淋巴结转移、区域外淋巴结转移、腹膜或其他远处部位）和诊断确定性（明确或可疑）对疾病部位进行分类。计算PET和传统成像检查中区域外复发阳性患者的比例。此外，计算每种检查方法仅存在不确定病变的患者比例，并列出不确定检查结果的部位。
共有85例患者（中位年龄50岁；范围：30 - 81岁），包括宫颈癌（n = 51）、子宫内膜癌（n = 18）、阴道癌（n = 6）或外阴癌（n = 10）。传统成像和PET检查分别在8/85（9.4%）和24/85（28.2%）的患者中检测到区域外复发（p = 0.0017）。与传统成像相比，PET在检测区域外淋巴结转移方面影响最大。PET检查中区域外复发可疑的检查明显少于传统成像（分别为6/85 [7.1%]和38/85 [44.7%]，p < 0.001）。
对于考虑行根治性挽救手术的复发性妇科恶性肿瘤患者，PET检测到的区域外复发可能明显多于传统成像。PET还可能减少可疑病变的数量。这些结果对患者管理和预后的影响应在未来的前瞻性试验中得到证实。
