Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Department of Nuclear Medicine, St James's Institute of Oncology, Leeds, UK.
Sci Rep. 2020 Mar 5;10(1):4086. doi: 10.1038/s41598-020-60739-3.
There is no consensus regarding optimal interpretative criteria (IC) for Fluorine-18 fluorodeoxyglucose (FDG) Positron Emission Tomography - Computed Tomography (PET-CT) response assessment following (chemo)radiotherapy (CRT) for head and neck squamous cell carcinoma (HNSCC). The aim was to compare accuracy of IC (NI-RADS, Porceddu, Hopkins, Deauville) for predicting loco-regional control and progression free survival (PFS). All patients with histologically confirmed HNSCC treated at a specialist cancer centre with curative-intent non-surgical treatment who underwent baseline and response assessment FDG PET-CT between August 2008 and May 2017 were included. Metabolic response was assessed using 4 different IC harmonised into 4-point scales (complete response, indeterminate, partial response, progressive disease). IC performance metrics (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy) were compared. Kaplan-Meier and Cox proportional hazards regression analyses were performed for survival analysis. 562 patients were included (397 oropharynx, 53 hypopharynx, 48 larynx, 64 other/unknown primary). 420 patients (75%) received CRT and 142 (25%) had radiotherapy alone. Median follow-up was 26 months (range 3-148). 156 patients (28%) progressed during follow-up. All IC were accurate for prediction of primary tumour (mean NPV 85.0% (84.6-85.3), PPV 85.0% (82.5-92.3), accuracy 84.9% (84.2-86.0)) and nodal outcome (mean NPV 85.6% (84.1-86.6), PPV 94.7% (93.8-95.1), accuracy 86.8% (85.6-88.0)). Number of indeterminate scores for NI-RADS, Porceddu, Deauville and Hopkins were 91, 25, 20, 13 and 55, 70, 18 and 3 for primary tumour and nodes respectively. PPV was significantly reduced for indeterminate uptake across all IC (mean PPV primary tumour 36%, nodes 48%). Survival analyses showed significant differences in PFS between response categories classified by each of the four IC (p <0.001). All four IC have similar diagnostic performance characteristics although Porceddu and Deauville scores offered the best trade off of minimising indeterminate outcomes whilst maintaining a high NPV.
对于头颈部鳞状细胞癌（HNSCC）接受放化疗（CRT）后氟代脱氧葡萄糖（FDG）正电子发射断层扫描-计算机断层扫描（PET-CT）的反应评估，目前尚无最佳的解释标准（IC）共识。本研究旨在比较不同 IC（NI-RADS、Porceddu、Hopkins、Deauville）预测局部区域控制和无进展生存期（PFS）的准确性。所有在癌症专科中心接受以治愈为目的的非手术治疗且经组织学证实的 HNSCC 患者均被纳入研究，这些患者于 2008 年 8 月至 2017 年 5 月期间接受了基线和反应评估 FDG PET-CT。使用 4 种不同的 IC（完全缓解、不确定、部分缓解、进展性疾病）将代谢反应评估分为 4 分制。比较了 IC 性能指标（敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、准确性）。采用 Kaplan-Meier 和 Cox 比例风险回归分析进行生存分析。共纳入 562 例患者（397 例口咽癌、53 例下咽癌、48 例喉癌、64 例其他/未知原发灶）。420 例（75%）患者接受 CRT，142 例（25%）仅接受放疗。中位随访时间为 26 个月（范围 3-148 个月）。156 例（28%）患者在随访期间出现进展。所有 IC 对预测原发肿瘤（平均 NPV 为 85.0%（84.6-85.3）、PPV 为 85.0%（82.5-92.3）、准确性为 84.9%（84.2-86.0））和淋巴结结果（平均 NPV 为 85.6%（84.1-86.6）、PPV 为 94.7%（93.8-95.1）、准确性为 86.8%（85.6-88.0））均具有较高的准确性。NI-RADS、Porceddu、Deauville 和 Hopkins 的不确定评分分别为 91、25、20、13 和 55、70、18、3 分。所有 IC 的不确定摄取的 PPV 均显著降低（原发肿瘤的平均 PPV 为 36%，淋巴结为 48%）。生存分析显示，根据 4 种 IC 分类的反应类别之间的 PFS 存在显著差异（p <0.001）。所有 4 种 IC 均具有相似的诊断性能特征，尽管 Porceddu 和 Deauville 评分在维持高 NPV 的同时，提供了最佳的不确定结果最小化的权衡。
