Fujiwara Masao, Suzuki Takahiro, Senoo Ayumi, Fukamizu Hidekazu, Tokura Yoshiki
Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
J Dermatol. 2017 Aug;44(8):939-943. doi: 10.1111/1346-8138.13833. Epub 2017 Mar 11.
Patients with extramammary Paget's disease (EMPD) have a relatively good prognosis, when spread of the tumor cells is limited to the epidermis. However, invasive EMPD has a poor prognosis, when the patients have regional lymph node metastasis. Detection of nodal metastasis is thus mandatory to manage EMPD. To evaluate the F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging to assess lymph node metastasis, 15 patients with histologically proven primary EMPD were enrolled in this study. All patients underwent whole-body PET prior to sentinel lymph node biopsy (SLNB). The maximum standardized uptake value (SUVmax) of more than 2.5 was evaluated as positive PET indicative of malignancy. Among 14 cases with the primary genital lesions, 11 cases underwent bilateral SLNB of the inguinal nodal basin and the remaining three cases unilateral SLNB. One case with a primary axillary lesion underwent unilateral SLNB of the axillary nodal basin. Therefore, a total of 26 regional basins were investigated. In general, nodal basins can be categorized into four groups: (i) histologically negative and PET negative (true negative); (ii) histologically positive and PET negative (false negative); (iii) histologically positive and PET positive (true positive); and (iv) histologically negative and PET positive (false positive) groups. In the 26 nodal basins, there were 19 true negative and seven true positive cases, and neither false negative nor false positive cases were observed. The mean SUVmax was significantly higher in the true positive basins (8.03 ± 3.34) than in the true negative basins (0.26 ± 0.56). The SUVmax value may be useful for detection of nodal metastasis.
当肿瘤细胞仅局限于表皮时，乳腺外佩吉特病（EMPD）患者的预后相对较好。然而，当患者出现区域淋巴结转移时，侵袭性EMPD的预后较差。因此，检测淋巴结转移对于EMPD的治疗至关重要。为了评估氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）成像在评估淋巴结转移中的作用，本研究纳入了15例经组织学证实为原发性EMPD的患者。所有患者在进行前哨淋巴结活检（SLNB）之前均接受了全身PET检查。最大标准化摄取值（SUVmax）大于2.5被评估为PET阳性，提示恶性肿瘤。在14例原发性生殖器病变的病例中，11例患者接受了双侧腹股沟淋巴结区域的SLNB，其余3例接受了单侧SLNB。1例原发性腋窝病变的患者接受了单侧腋窝淋巴结区域的SLNB。因此，总共对26个区域淋巴结进行了检查。一般来说，淋巴结区域可分为四组：（i）组织学阴性且PET阴性（真阴性）；（ii）组织学阳性且PET阴性（假阴性）；（iii）组织学阳性且PET阳性（真阳性）；（iv）组织学阴性且PET阳性（假阳性）组。在这26个淋巴结区域中，有19例假阴性和7例假阳性病例，未观察到假阴性或假阳性病例。真阳性区域的平均SUVmax（8.03±3.34）显著高于真阴性区域（0.26±0.56）。SUVmax值可能有助于检测淋巴结转移。
