Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri, USA.
Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York, USA.
Int J Gynecol Cancer. 2019 Nov;29(9):1351-1354. doi: 10.1136/ijgc-2019-000528. Epub 2019 Aug 30.
F-fluorodeoxyglucose-positron emission tomography (FDG-PET) detection of metastatic nodal disease is useful for guiding cervical cancer treatment but the impact of tumor histology is unknown. This study reports the detection of FDG avid pelvic and para-aortic lymph nodes in patients with early stage cervical cancer with squamous carcinoma and adenocarcinoma tumor histology.
Patients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB1-2 cervical cancer who underwent pre-surgical FDG-PET between March 1999 and February 2018 were identified in a tertiary academic center database. All patients had radical hysterectomy with pelvic and para-aortic lymph node dissection. Detection of pelvic and para-aortic lymph nodes by FDG-PET versus surgical dissection was compared. FDG-PET sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined and stratified by tumor histology.
We identified 212 patients with early stage cervical cancer (84% FIGO IB1, 16% IB2) who underwent pre-surgical FDG-PET; 137 (65%) patients had squamous carcinoma and 75 (35%) patients had adenocarcinoma. PET/computed tomography was performed in 189 (89%) patients and 23 (11%) had PET only. Surgical dissection revealed positive pelvic and para-aortic lymph nodes in 25% and 3.3% of patients, respectively. For squamous carcinoma, sensitivity, specificity, PPV, and NPV of FDG-PET for pelvic nodal metastasis were 44%, 99%, 95%, and 78%, respectively. For adenocarcinoma, the corresponding results for pelvic nodal metastasis were 25%, 99%, 67%, and 92%, respectively. The overall values for sensitivity, specificity, PPV, and NPV of FDG-PET for para-aortic nodal metastasis were 29%, 99%, 67%, and 98%, respectively.
Pelvic nodal metastasis was less likely to be detected by FDG-PET in patients with early stage adenocarcinoma than with squamous carcinoma.
氟-18 脱氧葡萄糖正电子发射断层扫描（FDG-PET）检测转移性淋巴结疾病对指导宫颈癌治疗很有用，但肿瘤组织学的影响尚不清楚。本研究报告了国际妇产科联合会（FIGO）2009 期 IB1-2 宫颈癌患者中，具有鳞癌和腺癌组织学肿瘤的患者中，盆腔和腹主动脉旁 FDG 摄取淋巴结的检测情况。
在一个三级学术中心的数据库中，确定了 1999 年 3 月至 2018 年 2 月间进行术前 FDG-PET 的国际妇产科联合会（FIGO）2009 期 IB1-2 宫颈癌患者。所有患者均接受根治性子宫切除术和盆腔及腹主动脉旁淋巴结清扫术。比较 FDG-PET 与手术解剖对盆腔和腹主动脉旁淋巴结的检测。根据肿瘤组织学，确定 FDG-PET 的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
我们确定了 212 例早期宫颈癌患者（84%为 FIGO IB1，16%为 IB2）接受了术前 FDG-PET；137 例（65%）患者为鳞癌，75 例（35%）患者为腺癌。189 例（89%）患者进行了 FDG-PET/CT 检查，23 例（11%）仅进行了 PET 检查。手术解剖显示，盆腔和腹主动脉旁淋巴结阳性的患者分别占 25%和 3.3%。对于鳞癌，FDG-PET 对盆腔淋巴结转移的敏感性、特异性、PPV 和 NPV 分别为 44%、99%、95%和 78%。对于腺癌，盆腔淋巴结转移的相应结果分别为 25%、99%、67%和 92%。FDG-PET 对腹主动脉旁淋巴结转移的敏感性、特异性、PPV 和 NPV 的总体值分别为 29%、99%、67%和 98%。
与鳞癌患者相比，早期腺癌患者的盆腔淋巴结转移更不易被 FDG-PET 检测到。
