术前 PET/CT 不能准确检测新诊断的高危型子宫内膜癌患者的子宫外疾病：一项前瞻性研究。
Preoperative PET/CT does not accurately detect extrauterine disease in patients with newly diagnosed high-risk endometrial cancer: A prospective study.
机构信息
Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
出版信息
Cancer. 2019 Oct 1;125(19):3347-3353. doi: 10.1002/cncr.32329. Epub 2019 Jun 21.
BACKGROUND
The identification of extrauterine disease is critical to the management of patients with high-risk endometrial cancer. The purpose of the current study was to determine the accuracy of preoperative positron emission tomography (PET)/computed tomography (CT) in the detection of extrauterine disease.
METHODS
Women with high-risk endometrial cancer were enrolled prospectively and underwent preoperative PET/CT followed by surgery, including sentinel lymph node biopsy and lymphadenectomy. Primary tumor factors on PET/CT were correlated with lymph node pathology. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the detection of lymphadenopathy and peritoneal disease by PET/CT.
RESULTS
A total of 112 patients were enrolled and underwent PET/CT between April 2013 and May 2016, 108 of whom were evaluable. On PET/CT, 21 patients (19.4%) were found to have extrauterine disease, 18 (17%) had positive lymph nodes, and 8 (7%) had peritoneal disease. A total of 108 patients underwent surgery, 103 of whom (95%) underwent lymphadenectomy. The sensitivity of PET/CT to detect positive lymph nodes was 45.8%, with a specificity of 91.1%, positive predictive value of 61.1%, and negative predictive value of 84.7%. The false-negative rate was 54.2%. There was no difference in primary tumor characteristics on imaging noted between patients with positive and negative lymph nodes. The sensitivity of PET/CT to detect peritoneal disease was 37.5%, with a specificity of 97.8%, positive predictive value of 75%, and negative predictive value of 90.0%. The false-negative rate was 62.5%.
CONCLUSIONS
Preoperative PET/CT did not reliably predict the presence of extrauterine disease in women with high-risk endometrial cancer. Given the high false-negative rates, PET/CT should not be used in the preoperative treatment planning of these patients.
背景
识别子宫外疾病对于高危子宫内膜癌患者的治疗至关重要。本研究旨在确定术前正电子发射断层扫描（PET）/计算机断层扫描（CT）在检测子宫外疾病中的准确性。
方法
前瞻性纳入高危子宫内膜癌患者，行术前 PET/CT 检查，随后行手术治疗，包括前哨淋巴结活检和淋巴结清扫术。PET/CT 上的原发肿瘤因素与淋巴结病理相关。计算 PET/CT 对淋巴结病和腹膜疾病的检测的敏感性、特异性、阳性预测值和阴性预测值。
结果
共纳入 112 例患者，于 2013 年 4 月至 2016 年 5 月行 PET/CT 检查，其中 108 例可评估。PET/CT 发现 21 例（19.4%）患者存在子宫外疾病，18 例（17%）患者有阳性淋巴结，8 例（7%）患者有腹膜疾病。108 例患者均行手术治疗，其中 103 例行淋巴结清扫术。PET/CT 检测阳性淋巴结的敏感性为 45.8%，特异性为 91.1%，阳性预测值为 61.1%，阴性预测值为 84.7%。假阴性率为 54.2%。PET/CT 上阳性和阴性淋巴结患者的原发肿瘤特征无差异。PET/CT 检测腹膜疾病的敏感性为 37.5%，特异性为 97.8%，阳性预测值为 75%，阴性预测值为 90.0%。假阴性率为 62.5%。
结论
术前 PET/CT 不能可靠预测高危子宫内膜癌患者子宫外疾病的存在。鉴于假阴性率高，PET/CT 不应用于这些患者的术前治疗计划。
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