Collarino Angela, Garganese Giorgia, Valdés Olmos Renato A, Stefanelli Antonella, Perotti Germano, Mirk Paoletta, Fragomeni Simona M, Ieria Francesco P, Scambia Giovanni, Giordano Alessandro, Rufini Vittoria
Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore-Fondazione Policlinico A. Gemelli, Rome, Italy
Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
J Nucl Med. 2017 Dec;58(12):1913-1918. doi: 10.2967/jnumed.117.194332. Epub 2017 May 25.
This study aimed to assess the value of dual-timepoint F-FDG PET/CT in the prediction of lymph node (LN) status in patients with invasive vulvar cancer (VC) scheduled for inguinofemoral LN dissection. From April 2013 to July 2015, all consecutive patients with VC scheduled for inguinofemoral LN dissection were prospectively enrolled. All patients underwent a preoperative whole-body F-FDG PET/CT scan at 1 h (standard examination) and an additional scan from T11 to the groins at 3 h (delayed examination) after F-FDG injection. On both scans, each groin was visually scored 0 or 1 concerning F-FDG LN uptake relative to background. Semiquantitative analysis included SUV and the corresponding retention index of SUV, measured on both scans. The optimal cutoff value of these parameters was defined using a receiver-operating-characteristic analysis. Histopathology was the standard of reference. Thirty-three patients were included, with a total of 57 groins dissected and histologically evaluated. At histopathology, 21 of 57 (37%) groins contained metastatic LNs. Concerning visual score, sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were 95.2%, 75%, 96.4%, 69%, and 82.5% on standard scanning and 95.2%, 77.8%, 96.6%, 71.4%, and 84.2% on delayed scanning, respectively. At receiver-operating-characteristic analysis, sensitivity and specificity were 95.2% and 77.8% on standard and delayed F-FDG PET/CT for an SUV cutoff of greater than 1.32 and 1.88, respectively, and 95.2% and 80% for a retention index of SUV cutoff of greater than 0. Standard F-FDG PET/CT is an effective preoperative imaging method for the prediction of LN status in VC, allowing the prediction of pathologically negative groins and thus the selection of patients suitable for minimally invasive surgery. Delayed F-FDG PET/CT did not improve the specificity and the positive predictive value in our series. Larger studies are needed for a further validation.
本研究旨在评估双时相F-FDG PET/CT在预测计划行腹股沟股淋巴结清扫术的浸润性外阴癌（VC）患者淋巴结（LN）状态中的价值。2013年4月至2015年7月，前瞻性纳入所有计划行腹股沟股淋巴结清扫术的连续性VC患者。所有患者在注射F-FDG后1小时接受术前全身F-FDG PET/CT扫描（标准检查），并在3小时后从T11至腹股沟进行额外扫描（延迟检查）。在两次扫描中，根据F-FDG在淋巴结中的摄取相对于背景情况，对每个腹股沟进行视觉评分，分为0或1分。半定量分析包括SUV以及在两次扫描中测量的SUV相应保留指数。使用受试者操作特征分析确定这些参数的最佳截断值。组织病理学为参考标准。共纳入33例患者，总共57个腹股沟进行了清扫并进行了组织学评估。在组织病理学检查中，57个腹股沟中有21个（37%）含有转移性淋巴结。关于视觉评分，标准扫描时的敏感性、特异性、阴性预测值、阳性预测值和准确性分别为95.2%、75%、96.4%、69%和82.5%，延迟扫描时分别为95.2%、77.8%、96.6%、71.4%和84.2%。在受试者操作特征分析中，对于SUV截断值分别大于1.32和1.88，标准和延迟F-FDG PET/CT的敏感性和特异性分别为95.2%和77.8%，对于SUV保留指数截断值大于0，敏感性和特异性分别为95.2%和80%。标准F-FDG PET/CT是预测VC患者LN状态的一种有效的术前成像方法，能够预测病理阴性的腹股沟，从而筛选出适合微创手术的患者。在我们的研究系列中，延迟F-FDG PET/CT并未提高特异性和阳性预测值。需要更大规模的研究进行进一步验证。
