Gouveia Patrícia, Sá Pinto Adriana, Violante Liliana, Nunes Sara, Teixeira Ricardo, Petiz Almerinda, Duarte Luís Hugo
Serviço de Medicina Nuclear. Centro Hospitalar do Porto. Porto. Portugal.
Serviço de Medicina Nuclear. Centro Hospitalar de São João. Porto. Portugal.
Acta Med Port. 2022 Mar 2;35(3):170-175. doi: 10.20344/amp.12510. Epub 2021 Nov 24.
Despite the growing evidence supporting the use of 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography in cervical and ovarian malignant tumours, data on vulvar and vaginal cancer is sparse. Our aim was to assess the role of 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography in patients with vulvar and vaginal cancer.
A retrospective study was conducted on a cohort of 20 patients with biopsy-proven vulvar (n = 17) and vaginal (n = 3) cancer who performed 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography, between January 2013 and April 2018. We collected the clinical data of all patients, as well as the indication for 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography, its results, and the main lesion maximum standard uptake value (SUVmax). In addition, we correlated the results of 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography with other diagnostic modalities, namely histological findings, computed tomography and magnetic resonance imaging. Patients were divided into two groups, one with newly diagnosed disease and another with recurrent disease.
Six patients had newly diagnosed disease and 14 had recurrent disease. The main lesion was detected by 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography in five out of six patients with newly diagnosed disease and in all 14 patients with recurrent disease. Additional sites of 2-[F-18]-fluor-2-desoxi-D-glucose uptake were identified in inguinal and iliac lymph nodes and in distant lesions. Magnetic resonance imaging and computed tomography were performed in 12 cases. In four patients with recurrent disease, abnormalities (main lesion/ metastatic lymph nodes) identified by 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography were not detected as suspicious by computed tomography.
In our study, 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography identified abnormalities more often than conventional computed tomography scans in recurrent disease. In comparison with histology, 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography had a sensitivity of 95% and a positive predictive value of 100% in identifying the primary tumour and the recurrent main lesion. Little data is available regarding the usefulness of 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography in the management of vulvar and vaginal cancers. The existing evidence supports a high accuracy in detecting lymph node metastases and a change of 36.0% - 61.5% in patient management. Our findings reinforce the usefulness of this technique in vulvar and vaginal cancer. Limitations of our study include its retrospective nature and the rareness of both vulvar and vaginal cancer, which leads to a small sample size and few comparative imaging tests.
In this preliminary study, 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography demonstrated it can be a useful method in patients with vulvar and vaginal cancers, namely in defining the extent of disease and contributing to accurate staging and restaging.
尽管越来越多的证据支持2-[F-18]-氟-2-脱氧-D-葡萄糖正电子发射断层扫描/计算机断层扫描在宫颈癌和卵巢恶性肿瘤中的应用，但关于外阴癌和阴道癌的数据却很稀少。我们的目的是评估2-[F-18]-氟-2-脱氧-D-葡萄糖正电子发射断层扫描/计算机断层扫描在外阴癌和阴道癌患者中的作用。
对20例经活检证实为外阴癌（n = 17）和阴道癌（n = 3）的患者进行了一项回顾性研究，这些患者在2013年1月至2018年4月期间接受了2-[F-18]-氟-2-脱氧-D-葡萄糖正电子发射断层扫描/计算机断层扫描。我们收集了所有患者的临床数据，以及2-[F-18]-氟-2-脱氧-D-葡萄糖正电子发射断层扫描/计算机断层扫描的指征、结果和主要病变的最大标准摄取值（SUVmax）。此外，我们将2-[F-18]-氟-2-脱氧-D-葡萄糖正电子发射断层扫描/计算机断层扫描的结果与其他诊断方法，即组织学检查结果、计算机断层扫描和磁共振成像进行了关联。患者分为两组，一组为新诊断疾病患者，另一组为复发疾病患者。
6例患者为新诊断疾病，14例为复发疾病。在6例新诊断疾病患者中的5例以及所有14例复发疾病患者中，2-[F-18]-氟-2-脱氧-D-葡萄糖正电子发射断层扫描/计算机断层扫描检测到了主要病变。在腹股沟和髂淋巴结以及远处病变中发现了2-[F-18]-氟-2-脱氧-D-葡萄糖摄取的其他部位。12例患者进行了磁共振成像和计算机断层扫描。在4例复发疾病患者中，计算机断层扫描未将2-[F-18]-氟-2-脱氧-D-葡萄糖正电子发射断层扫描/计算机断层扫描发现的异常（主要病变/转移性淋巴结）检测为可疑病变。
在我们的研究中，2-[F-18]-氟-2-脱氧-D-葡萄糖正电子发射断层扫描/计算机断层扫描在复发疾病中比传统计算机断层扫描更常发现异常。与组织学相比，2-[F-18]-氟-2-脱氧-D-葡萄糖正电子发射断层扫描/计算机断层扫描在识别原发性肿瘤和复发主要病变方面的敏感性为95%，阳性预测值为100%。关于2-[F-18]-氟-2-脱氧-D-葡萄糖正电子发射断层扫描/计算机断层扫描在外阴癌和阴道癌管理中的有用性的数据很少。现有证据支持其在检测淋巴结转移方面具有较高的准确性，并且在患者管理方面有36.0% - 61.5%的变化。我们的研究结果强化了这项技术在外阴癌和阴道癌中的有用性。我们研究的局限性包括其回顾性性质以及外阴癌和阴道癌的罕见性，这导致样本量小且比较成像检查少。
在这项初步研究中，2-[F-18]-氟-2-脱氧-D-葡萄糖正电子发射断层扫描/计算机断层扫描表明它在外阴癌和阴道癌患者中可能是一种有用的方法，即有助于确定疾病范围并有助于准确分期和再分期。
