Nakanishi Yukako, Kitajima Kazuhiro, Yamada Yusuke, Hashimoto Takahiko, Suzuki Toru, Go Shuken, Kanematsu Akihiro, Nojima Michio, Yamakado Koichiro, Yamamoto Shingo
Department of Urology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
Department of Radiology, Division of Nuclear Medicine and PET Center, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
Ann Nucl Med. 2018 Dec;32(10):658-668. doi: 10.1007/s12149-018-1287-3. Epub 2018 Aug 17.
To compare findings obtained with C-choline and FDG PET/CT scanning for renal cell carcinoma staging and restaging.
Twenty-eight renal cell carcinoma patients whose histological subtype was clear cell type in 26 and papillary type in 2, while Fuhrman nuclear grade was G1,2 in 16 and G3,4 in 12, underwent both C-choline and FDG PET/CT examinations before (n = 10) and/or after (n = 18) treatment, then those scanning modalities were compared in regard to patient- and lesion-based diagnostic performance using 5 grading scores. Final diagnosis in each case was obtained based on histopathology, conventional radiological imaging, and clinical follow-up findings. The differences between C-choline and FDG PET/CT findings were evaluated using receiver-operating-characteristic (ROC) analysis and a McNemar test.
Patient-based sensitivity, specificity, positive predictive, negative predictive, accuracy, and area under the ROC curve (AUC) values for C-choline PET/CT for staging and restaging were 88.0% (22/25), 66.7% (2/3), 95.7% (22/23), 40.0% (2/5), 85.7% (24/28), and 0.887, respectively, while those for FDG-PET/CT were 56.0% (14/25), 66.7% (2/3), 93.3% (14/15), 15.4% (2/13), 57.1% (16/28), and 0.647, respectively. Sensitivity, accuracy, and AUC were significantly different (p = 0.013, p = 0.013, p = 0.012, respectively). Among the 120 lesions, those with kidney, lung, lymph node, bone, pancreas, venous tumor thrombosis, adrenal gland, liver, or skin localization numbered 15, 64, 16, 13, 4, 3, 2, 2, and 1, respectively. For all 120 lesions, 75 (62.5%) and 47 (39.2%) were detected by C-choline and FDG PET/CT, respectively (p < 0.0001).
For staging and restaging of renal cell carcinoma patients, C-choline-PET/CT is significantly more useful than FDG-PET/CT.
比较C胆碱和氟代脱氧葡萄糖（FDG）PET/CT扫描用于肾细胞癌分期及再分期的结果。
28例肾细胞癌患者，其中26例组织学亚型为透明细胞型，2例为乳头状型；Fuhrman核分级G1、2级16例，G3、4级12例。10例患者在治疗前、18例患者在治疗前和/或治疗后接受了C胆碱和FDG PET/CT检查，然后使用5级评分系统比较这两种扫描方式基于患者和病灶的诊断性能。每例患者的最终诊断基于组织病理学、传统放射影像学及临床随访结果。采用受试者操作特征（ROC）分析和McNemar检验评估C胆碱和FDG PET/CT结果的差异。
C胆碱PET/CT用于分期及再分期时，基于患者的敏感性、特异性、阳性预测值、阴性预测值、准确性及ROC曲线下面积（AUC）分别为88.0%（22/25）、66.7%（2/3）、95.7%（22/23）、40.0%（2/5）、85.7%（24/28）和0.887，而FDG-PET/CT的相应值分别为56.0%（14/25）、66.7%（2/3）、93.3%（14/15）、15.4%（2/13）、57.1%（16/28）和0.647。敏感性、准确性和AUC有显著差异（p分别为0.013、0.013、0.012）。在120个病灶中，位于肾脏、肺、淋巴结、骨、胰腺、静脉瘤栓、肾上腺、肝脏或皮肤的病灶分别有15个、64个、16个、13个、4个、3个、2个、2个和1个。对于所有120个病灶，C胆碱和FDG PET/CT分别检测到75个（62.5%）和47个（39.2%）（p<0.0001）。
对于肾细胞癌患者的分期及再分期，C胆碱PET/CT比FDG-PET/CT显著更有用。
