Elliott Hugh S, Metser Ur, de Perrot Marc, Cho John, Bradbury Penelope, Veit-Haibach Patrick, Hussey Douglas, Noam Tau
1 Joint Department of Medical Imaging, Princess Margaret Cancer Centre, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto , Toronto, ON , Canada.
2 Division of Thoracic Surgery, Princess Margaret Cancer Centre and Toronto General Hospital, University Health Network, University of Toronto , Toronto, ON , Canada.
Br J Radiol. 2018 Jun;91(1086):20170814. doi: 10.1259/bjr.20170814. Epub 2018 Mar 29.
To compare the N- and M-staging accuracy of PET vs CT, as per the American Joint Committee on Cancer (AJCC) eighth edition in patients with malignant pleural mesothelioma (MPM) being considered for multimodality therapy in a tertiary referral center. A secondary aim was to assess survival outcome of patients chosen for surgical management after PET.
A retrospective, single institution comparison of PET and CT was performed in patients with histologically proven MPM being considered for multimodality therapy. Performance of each modality in identifying nodal category and presence or absence of distant metastases was abstracted from electronic patient records. The standard of reference was surgical histopathology for nodal stage and histopathology or clinical and imaging follow-up of >3 months for distant metastases.
There were 101 eligible patients with complete data sets; 82 males, 19 females with a mean age of 66.6 years (range: 39-85). Most patients (n = 68) had epithelioid histology. Surgery was performed in 61/101 patients (60.4%), most of whom had multimodality therapy. Nodal category was concordant to surgical histopathology in 38/60 patients (63.3%) on PET, compared to 27/60 (45%) on CT (p = 0.001). For detection of ≥N1 disease only, PET and CT correctly staged 15/37 patients (40.5%) and 8/37 (21.6%), respectively (p = 0.023). Distant metastases were identified uniquely on PET in eight patients and on CT only in one patient. Overall, PET and CT correctly identified 11/12 (91.6%) and 4/12 (33.3%) patients with distant metastases, respectively (p = 0.0391).
PET identifies significantly more patients with nodal or distant metastatic disease than CT and may contribute to more appropriate selection of patients with MPM for surgery or multimodality therapy. Advances in knowledge: In patients with MPM, fludeoxyglucose-PET/CT detects significantly more patients with distant metastases than CT. PET/CT can help in the selection of patients with MPM who would benefit from surgery or multimodality therapy.
根据美国癌症联合委员会（AJCC）第八版，比较正电子发射断层扫描（PET）与计算机断层扫描（CT）在三级转诊中心接受多模态治疗的恶性胸膜间皮瘤（MPM）患者中的N分期和M分期准确性。次要目的是评估PET检查后选择手术治疗的患者的生存结果。
对组织学确诊为MPM且考虑接受多模态治疗的患者进行PET与CT的回顾性单机构比较。从电子病历中提取每种检查方式在识别淋巴结类别以及有无远处转移方面的表现。参考标准为淋巴结分期的手术组织病理学检查以及远处转移的组织病理学检查或>3个月的临床和影像学随访。
有101例患者拥有完整数据集；82例男性，19例女性，平均年龄66.6岁（范围：39 - 85岁）。大多数患者（n = 68）为上皮样组织学类型。61/101例患者（60.4%）接受了手术，其中大多数接受了多模态治疗。PET检查显示，60例患者中有38例（63.3%）的淋巴结类别与手术组织病理学检查结果一致，而CT检查的这一比例为27/60（45%）（p = 0.001）。仅对于检测≥N1期疾病，PET和CT分别正确分期15/37例患者（40.5%）和8/37例患者（21.6%）（p = 0.023）。8例患者仅通过PET发现远处转移，仅1例患者通过CT发现远处转移。总体而言，PET和CT分别正确识别出11/12例（91.6%）和4/12例（33.3%）有远处转移的患者（p = 0.0391）。
与CT相比，PET能识别出更多有淋巴结或远处转移疾病的患者，可能有助于更合理地选择适合手术或多模态治疗的MPM患者。知识进展：在MPM患者中，氟脱氧葡萄糖 - PET/CT检测到远处转移的患者明显多于CT。PET/CT有助于选择能从手术或多模态治疗中获益的MPM患者。
