Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, Tuebingen, Germany.
Department of Women's Health, University Hospital Zurich, Zurich, Switzerland.
J Nucl Med. 2021 Aug 1;62(8):1062-1067. doi: 10.2967/jnumed.120.255919. Epub 2021 Jan 28.
Lymph node metastasis (LNM) is present in a minority of patients with early stages of cervical carcinomas. As conventional imaging including PET/CT has shown limited sensitivity, systematic lymphadenectomies are often conducted for staging purposes. Therefore, the aim of this prospective study was to analyze the impact of F-FDG PET/MRI in addition to sentinel lymph node (SLN) biopsy on lymph node (LN) status. Forty-two women with an initial diagnosis of Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) IA-IIB cervical carcinoma were included between March 2016 and April 2019. Each patient underwent preoperative whole-body F-FDG PET/MRI and SLN imaging with SPECT/CT after intracervical injection of Tc-labeled nanocolloid. Systematic lymphadenectomy and SLN biopsy served as the reference standard. Staging using PET/MRI was performed by nuclear medicine and radiology experts working in consensus. One patient was excluded from surgical staging because of liver metastases newly diagnosed on PET/MRI. The overall prevalence of LNM in the remaining 41 patients was 29.3% (12/41). Five of 12 patients with LNM had solely small metastases with a maximum diameter of 5 mm. The consensus interpretation showed PET/MRI to have a specificity of 100% (29/29; 95% CI, 88.3%-100%) for LNM staging but a low sensitivity, 33.3% (4/12; 95% CI, 12.8%-60.9%). LN size was the most important factor for the detectability of metastases, since only LNMs larger than 5 mm could be identified by PET/MRI (sensitivity, 57.1% for >5 mm and 0% for ≤5 mm). Paraaortic LNM was evaluated accurately in 3 of the 4 patients with paraaortic LN metastasis. SLNs were detectable by SPECT/CT in 82.9% of the patients or 69.0% of the hemipelves. In cases with an undetectable SLN on SPECT/CT, the malignancy rate was considerably higher (31.2% vs. 19.3%). The combination of PET/MRI and SLN SPECT/CT improved the detection of pelvic LNM from 33.3% to 75%. F-FDG PET/MRI is a highly specific N-staging method and improves LNM detection. Because of the limited sensitivity in frequently occurring small LNMs, PET/MRI should be combined with SLN mapping. The proposed combined protocol helps to decide whether extensive surgical staging is necessary in patients with FIGO I/II cervical cancer.
淋巴结转移（LNM）存在于少数早期宫颈癌患者中。由于包括 PET/CT 在内的常规影像学检查显示出有限的敏感性，因此通常为了分期目的而进行系统性淋巴结切除术。因此，本前瞻性研究的目的是分析 F-FDG PET/MRI 联合前哨淋巴结（SLN）活检对淋巴结（LN）状态的影响。
2016 年 3 月至 2019 年 4 月期间，纳入了 42 名初始诊断为国际妇产科联盟（FIGO）IA-IIB 宫颈癌的女性患者。每位患者均接受了术前全身 F-FDG PET/MRI 和经宫颈注射 Tc 标记的纳米胶体后的 SPECT/CT SLN 成像。系统淋巴结切除术和 SLN 活检作为参考标准。使用核医学和放射学专家进行的共识对 PET/MRI 进行分期。由于 PET/MRI 新诊断出肝转移，1 名患者被排除在手术分期之外。在其余 41 名患者中，LNM 的总体患病率为 29.3%（12/41）。12 名 LNM 患者中有 5 名仅存在最大直径为 5mm 的小转移灶。共识解释表明，PET/MRI 对 LNM 分期具有 100%的特异性（29/29；95%CI，88.3%-100%），但敏感性较低，为 33.3%（4/12；95%CI，12.8%-60.9%）。LN 大小是检测转移的最重要因素，因为只有大于 5mm 的 LNMs 才能通过 PET/MRI 识别（敏感性，>5mm 为 57.1%，≤5mm 为 0%）。在 4 名存在主动脉旁 LN 转移的患者中，3 名准确评估了主动脉旁 LNM。SPECT/CT 可检测到 82.9%的患者或 69.0%的半骨盆中的 SLN。在 SPECT/CT 无法检测到 SLN 的情况下，恶性肿瘤的发生率明显更高（31.2%比 19.3%）。PET/MRI 和 SLN SPECT/CT 的组合将盆腔 LNM 的检测率从 33.3%提高到 75%。F-FDG PET/MRI 是一种高度特异的 N 分期方法，可提高 LNM 的检出率。由于在经常发生的小 LNM 中敏感性有限，因此 PET/MRI 应与 SLN 绘图相结合。所提出的联合方案有助于决定是否需要对 FIGO I/II 期宫颈癌患者进行广泛的手术分期。
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