Jung Wonguen, Park Kyung Ran, Lee Kyung-Ja, Kim Kyubo, Lee Jihae, Jeong Songmi, Kim Yi-Jun, Kim Jiyoung, Yoon Hai-Jeon, Kang Byung-Chul, Koo Hae Soo, Sung Sun Hee, Cho Min-Sun, Park Sanghui
Department of Radiation Oncology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea.
Department of Nuclear Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea.
Radiat Oncol J. 2017 Dec;35(4):340-348. doi: 10.3857/roj.2017.00206. Epub 2017 Dec 15.
To evaluate the diagnostic accuracy of computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT) in predicting pelvic lymph node (LN) metastases in patients with cervical cancer.
From January 2009 to March 2015, 114 patients with FIGO stage IA1-IIB uterine cervical cancer who underwent hysterectomy with pelvic lymphadenectomy and took CT, MRI, and PET/CT before surgery were enrolled in this study. The criteria for LN metastases were a LN diameter ≥1.0 cm and/or the presence of central necrosis on CT, a LN diameter ≥1.0 cm on MRI, and a focally increased FDG uptake on PET/CT. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for pelvic LN metastases were estimated.
The sensitivity, specificity, PPV, NPV, and accuracy for detection of pelvic LN metastases were 51.4%, 85.9%, 41.3%, 90.1%, and 80.3% for CT; 24.3%, 96.3%, 56.3%, 86.8%, and 84.6% for MRI; and 48.6%, 89.5%, 47.4%, 90.0%, and 82.9% for PET/CT, respectively. The sensitivity of PET/CT and CT was higher than that of MRI (p=0.004 and p= 0.013, respectively). The specificity of MRI was higher than those of PET/CT and CT (p=0.002 and p=0.001, respectively). The difference of specificity between PET/CT and CT was not statistically significant (p=0.167).
These results indicate that preoperative CT, MRI, and PET/CT showed low to moderate sensitivity and PPV, and moderate to high specificity, NPV, and accuracy. More efforts are necessary to improve sensitivity of imaging modalities in order to predict pelvic LN metastases.
评估计算机断层扫描（CT）、磁共振成像（MRI）及正电子发射断层扫描/计算机断层扫描（PET/CT）对宫颈癌患者盆腔淋巴结（LN）转移的诊断准确性。
2009年1月至2015年3月，114例国际妇产科联盟（FIGO）分期为IA1-IIB期的子宫颈癌患者纳入本研究，这些患者均接受了子宫切除术及盆腔淋巴结清扫术，且术前均进行了CT、MRI及PET/CT检查。LN转移的标准为：CT显示LN直径≥1.0 cm和/或存在中央坏死；MRI显示LN直径≥1.0 cm；PET/CT显示FDG摄取局部增加。评估盆腔LN转移的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）及准确性。
CT检测盆腔LN转移的敏感性、特异性、PPV、NPV及准确性分别为51.4%、85.9%、41.3%、90.1%及80.3%；MRI分别为24.3%、96.3%、56.3%、86.8%及84.6%；PET/CT分别为48.6%、89.5%、47.4%、90.0%及82.9%。PET/CT和CT的敏感性高于MRI（分别为p=0.004和p=0.013）。MRI的特异性高于PET/CT和CT（分别为p=0.002和p=0.001）。PET/CT与CT之间特异性的差异无统计学意义（p=0.167）。
这些结果表明，术前CT、MRI及PET/CT显示出低至中度的敏感性和PPV，以及中度至高的特异性、NPV和准确性。为预测盆腔LN转移，需要做出更多努力以提高成像方式的敏感性。
