Section of Nuclear Medicine, University Department of Radiological Sciences and Haematology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy.
Unit of Nuclear Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Eur J Nucl Med Mol Imaging. 2021 Sep;48(10):3303-3314. doi: 10.1007/s00259-021-05257-8. Epub 2021 Feb 23.
This retrospective study aimed to assess the diagnostic performance of preoperative [F]FDG-PET/CT in predicting the groin and pelvic lymph node (LN) status in a large single-centre series of vulvar cancer patients.
Between January 2013 and October 2018, among all consecutive women with proven vulvar cancer submitted to [F]FDG-PET/CT, 160 patients were included. LNs were analysed by two qualitative methods assessing PET information (defined as visual assessment) and a combination of PET and low-dose CT information (defined as overall assessment), respectively, as well as semi-quantitative analysis (LN-SUV). Sensitivity, specificity, accuracy, positive and negative predictive values (PPV and NPV) in predicting the groin and pelvic LN status were calculated in the overall study population; a subset analysis of groin parameters in clinically/ultrasonography negative patients was also performed. Histopathology was the reference standard.
All patients underwent vulvar and inguinofemoral LN surgery, and 35 pelvic LN surgery. Overall, 338 LN sites (296 groins and 42 pelvic sites) were histologically examined with 30.4% prevalence of metastatic groins and 28.6% for metastatic pelvic sites. In the overall study population, sensitivity (95% confidence interval, CI), specificity (95% CI), accuracy (95% CI), PPV (95% CI) and NPV (95% CI) at the groin level were 85.6% (78.3-92.8), 65.5% (59.0-72.0), 71.6% (66.5-76.8), 52.0% (44.0-60.1) and 91.2% (86.7-95.8) for visual assessment; 78.9% (70.5-87.3), 78.2% (72.5-83.8), 78.4% (73.7-83.1), 61.2% (52.3-70.1) and 89.4% (85.0-93.9) for overall assessment; and 73.3% (64.2-82.5), 85.0% (80.1-89.8), 81.4% (77.0-85.8), 68.0% (58.8-77.3) and 87.9% (83.4-92.5) for semi-quantitative analysis (SUV cut-off value 1.89 achieved by ROC analysis). Similar results were observed in the pelvis-based analysis.
In this large single-centre series of vulvar cancer patients, [F]FDG-PET/CT showed good values of sensitivity and NPV in discriminating metastatic from non-metastatic LNs. In routine clinical practice, qualitative analysis is a reliable interpretative criterion making unnecessary commonly used semi-quantitative methods such as SUV.
本回顾性研究旨在评估术前 [F]FDG-PET/CT 在预测大样本单一中心外阴癌患者腹股沟和盆腔淋巴结（LN）状态方面的诊断性能。
2013 年 1 月至 2018 年 10 月，在所有经证实患有外阴癌并接受 [F]FDG-PET/CT 的连续女性患者中，纳入 160 例患者。通过两种定性方法（定义为视觉评估）和一种 PET 和低剂量 CT 信息相结合的方法（定义为总体评估）分别对 LN 进行分析，以及半定量分析（LN-SUV）。在整个研究人群中计算了预测腹股沟和盆腔 LN 状态的灵敏度、特异性、准确性、阳性预测值（PPV）和阴性预测值（NPV）；还对临床/超声阴性患者的腹股沟参数进行了亚组分析。组织病理学是参考标准。
所有患者均接受了外阴和腹股沟股淋巴结手术，35 例接受了盆腔淋巴结手术。总共检查了 338 个 LN 部位（296 个腹股沟和 42 个盆腔部位），腹股沟转移性淋巴结的患病率为 30.4%，盆腔转移性淋巴结的患病率为 28.6%。在整个研究人群中，腹股沟水平的灵敏度（95%置信区间，CI）、特异性（95%CI）、准确性（95%CI）、PPV（95%CI）和 NPV（95%CI）分别为 85.6%（78.3-92.8）、65.5%（59.0-72.0）、71.6%（66.5-76.8）、52.0%（44.0-60.1）和 91.2%（86.7-95.8）；78.9%（70.5-87.3）、78.2%（72.5-83.8）、78.4%（73.7-83.1）、61.2%（52.3-70.1）和 89.4%（85.0-93.9）；73.3%（64.2-82.5）、85.0%（80.1-89.8）、81.4%（77.0-85.8）、68.0%（58.8-77.3）和 87.9%（83.4-92.5）。半定量分析（通过 ROC 分析获得的 SUV 截断值为 1.89）也得到了类似的结果。
在这项大型单一中心外阴癌患者研究中，[F]FDG-PET/CT 在区分转移性和非转移性淋巴结方面具有良好的灵敏度和 NPV 值。在常规临床实践中，定性分析是一种可靠的解释标准，不需要常用的半定量方法（如 SUV）。
