OuYang Pu-Yun, Liu Zhi-Qiao, Lin Qing-Guang, He Yun, Guo Zhi-Xin, Yao Wen-Yan, Xu Sen-Kui, Peng Qing-He, Xiao Su-Ming, Li Jiajian, Li Anwei, Zhang Bao-Yu, Yang Shan-Shan, Fan Wei, Xie Chuan-Miao, Wu Yi-Shan, Zhang Xu, Chen Chun-Yan, Xie Fang-Yun
Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, No. 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China.
Department of Ultrasound, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, China.
Eur J Nucl Med Mol Imaging. 2023 Feb;50(3):881-891. doi: 10.1007/s00259-022-06020-3. Epub 2022 Oct 27.
To compare PET/CT, MRI and ultrasonography in detecting recurrence of nasopharyngeal carcinoma and identify their benefit in staging, contouring and overall survival (OS).
Cohort A included 1453 patients with or without histopathology-confirmed local recurrence, while cohort B consisted of 316 patients with 606 histopathology-confirmed lymph nodes to compare the sensitivities and specificities of PET/CT, MRI and ultrasonography using McNemar test. Cohorts C and D consisted of 273 patients from cohort A and 267 patients from cohort B, respectively, to compare the distribution of PET/CT-based and MRI-based rT-stage and rN-stage and the accuracy of rN-stage using McNemar test. Cohort E included 30 random patients from cohort A to evaluate the changes in contouring with or without PET/CT by related-samples T test or Wilcoxon rank test. The OS of 61 rT3-4N0M0 patients staged by PET/CT plus MRI (cohort F) and 67 MRI-staged rT3-4N0M0 patients (cohort G) who underwent similar salvage treatment were compared by log-rank test and Cox regression.
PET/CT had similar specificity to MRI but higher sensitivity (93.9% vs. 79.3%, P < 0.001) in detecting local recurrence. PET/CT, MRI and ultrasonography had comparable specificities, but PET/CT had greater sensitivity than MRI (90.9% vs. 67.6%, P < 0.001) and similar sensitivity to ultrasonography in diagnosing lymph nodes. According to PET/CT, more patients were staged rT3-4 (82.8% vs. 68.1%, P < 0.001) or rN + (89.9% vs. 69.3%, P < 0.001), and the rN-stage was more accurate (90.6% vs. 73.8%, P < 0.001). Accordingly, the contours of local recurrence were more precise (median Dice similarity coefficient 0.41 vs. 0.62, P < 0.001) when aided by PET/CT plus MRI. Patients staged by PET/CT plus MRI had a higher 3-year OS than patients staged by MRI alone (85.5% vs. 60.4%, P = 0.006; adjusted HR = 0.34, P = 0.005).
PET/CT more accurately detected and staged recurrence of nasopharyngeal carcinoma and accordingly complemented MRI, providing benefit in contouring and OS.
比较正电子发射断层显像/计算机断层扫描（PET/CT）、磁共振成像（MRI）和超声检查在鼻咽癌复发检测中的应用，并确定它们在分期、勾画轮廓和总生存期（OS）方面的优势。
队列A包括1453例有或无组织病理学确诊局部复发的患者，队列B由316例有606个组织病理学确诊淋巴结的患者组成，使用McNemar检验比较PET/CT、MRI和超声检查的敏感性和特异性。队列C和队列D分别由队列A中的273例患者和队列B中的267例患者组成，使用McNemar检验比较基于PET/CT和基于MRI的rT分期和rN分期的分布以及rN分期的准确性。队列E包括队列A中的30例随机患者，通过相关样本t检验或Wilcoxon秩和检验评估有无PET/CT时轮廓勾画的变化。通过对数秩检验和Cox回归比较PET/CT联合MRI分期（队列F）的61例rT3-4N0M0患者和MRI分期（队列G）的67例rT3-4N0M0患者在接受类似挽救性治疗后的OS。
在检测局部复发方面，PET/CT与MRI具有相似的特异性，但敏感性更高（93.9%对79.3%，P<0.001）。PET/CT、MRI和超声检查具有相当的特异性，但PET/CT在诊断淋巴结方面比MRI具有更高的敏感性（90.9%对67.6%，P<0.001），与超声检查的敏感性相似。根据PET/CT，更多患者被分期为rT3-4（82.8%对68.1%，P<0.001）或rN+（89.9%对69.3%，P<0.001），且rN分期更准确（90.6%对73.8%，P<0.001）。因此，在PET/CT联合MRI辅助下，局部复发的轮廓更精确（中位Dice相似系数0.41对0.
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