Helsen Nils, Van den Wyngaert Tim, Carp Laurens, De Bree Remco, VanderVeken Olivier M, De Geeter Frank, Maes Alex, Cambier Jean-Philippe, Spaepen Karoline, Martens Michel, Hakim Sara, Beels Laurence, Hoekstra Otto S, Van den Weyngaert Danielle, Stroobants Sigrid, Van Laer Carl, Specenier Pol, Maes Annelies, Debruyne Philip, Hutsebaut Isabel, Van Dinter Joost, Homans Filip, Goethals Laurence, Lenssen Oliver, Deben Kristof
Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.
Faculty of Medicine and Health Sciences, University of Antwerp, wilrijk, 2650, Antwerp, Belgium.
Eur J Nucl Med Mol Imaging. 2020 May;47(5):1075-1082. doi: 10.1007/s00259-020-04710-4. Epub 2020 Feb 10.
The Hopkins criteria were introduced for nodal response evaluation after therapy in head and neck cancer, but its superiority over quantification is not yet confirmed.
SUV thresholds and lesion-to-background ratios were explored in a prospective multicenter study of standardized FDG-PET/CT 12 weeks after CRT in newly diagnosed locally advanced head and neck squamous cell carcinoma (LAHNSCC) patients (ECLYPS). Reference standard was histology, negative FDG-PET/CT at 12 months after treatment or ≥ 2 years of negative follow-up. Area under the receiver operator characteristics curves (AUROC) were estimated and obtained thresholds were validated in an independent cohort of HNSCC patients (n = 127).
In ECLYPS, 124 patients were available for quantification. With a median follow-up of 20.4 months, 23 (18.5%) nodal neck recurrences were observed. A SUV threshold of 2.2 (AUROC = 0.89; sensitivity = 79.7%; specificity = 80.8%) was identified as optimal metric to identify nodal recurrence within 1 year after therapy. For lesion-to-background ratios, an SUV/SUV threshold of 0.96 (AUROC = 0.89; sensitivity = 79.7%; specificity = 82.8%) had the best performance. Compared with Hopkins criteria (AUROC = 0.81), SUV and SUV/SUV provided a borderline significant (p = 0.040 and p = 0.094, respectively) improvement. Validation of thresholds yielded similar AUROC values (SUV = 0.93, SUV/SUV = 0.95), and were comparable to the Hopkins score (AUROC = 0.91; not statistically significant).
FDG quantification detects nodal relapse in LAHNSCC patients. When using EARL standardized PET acquisitions and reconstruction, absolute SUV metrics (SUV threshold 2.2) prove robust, yet ratios (SUV/SUV, threshold 0.96) may be more useful in routine clinical care. In this setting, the diagnostic value of quantification is comparable to the Hopkins criteria.
US National Library for Medicine, NCT01179360. Registered 11 August 2010, https://clinicaltrials.gov/ct2/show/NCT01179360.
霍普金斯标准被引入用于评估头颈部癌治疗后的淋巴结反应，但它相对于定量分析的优越性尚未得到证实。
在一项前瞻性多中心研究中，对新诊断的局部晚期头颈部鳞状细胞癌（LAHNSCC）患者（ECLYPS）同步放化疗12周后进行标准化氟代脱氧葡萄糖正电子发射断层显像/计算机断层扫描（FDG-PET/CT），探索SUV阈值和病变与背景比值。参考标准为组织学检查、治疗后12个月FDG-PET/CT阴性或随访≥2年阴性。估计受试者操作特征曲线下面积（AUROC），并在一组独立的头颈部鳞状细胞癌患者（n = 127）中验证获得的阈值。
在ECLYPS研究中，124例患者可用于定量分析。中位随访20.4个月，观察到23例（18.5%）颈部淋巴结复发。SUV阈值为2.2（AUROC = 0.89；敏感性 = 79.7%；特异性 = 80.8%）被确定为识别治疗后1年内淋巴结复发的最佳指标。对于病变与背景比值，SUV/SUV阈值为0.96（AUROC = 0.89；敏感性 = 79.7%；特异性 = 82.8%）表现最佳。与霍普金斯标准（AUROC = 0.81）相比，SUV和SUV/SUV有边缘性显著改善（分别为p = 0.040和p = 0.094）。阈值验证产生了相似的AUROC值（SUV = 0.93，SUV/SUV = 0.95），且与霍普金斯评分相当（AUROC = 0.91；无统计学意义）。
FDG定量分析可检测LAHNSCC患者的淋巴结复发。当使用EARL标准化PET采集和重建时，绝对SUV指标（SUV阈值2.2）证明是可靠的，但比值（SUV/SUV，阈值0.96）在常规临床护理中可能更有用。在这种情况下，定量分析的诊断价值与霍普金斯标准相当。
美国国立医学图书馆，NCT01179360。2010年8月11日注册，https://clinicaltrials.gov/ct2/show/NCT01179360。
