NI-RADS 用于评估头颈部鳞癌根治性放化疗后 FDG-PET/CECT 应答的诊断性能

Diagnostic Performance of Response Assessment FDG-PET/CECT in HNSCC Treated With Definitive Radio(chemo)therapy Using NI-RADS.

机构信息

Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India.

Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India.

出版信息

Otolaryngol Head Neck Surg. 2023 Oct;169(4):938-947. doi: 10.1002/ohn.305. Epub 2023 Mar 1.

DOI:10.1002/ohn.305

PMID:36856038

Abstract

OBJECTIVE

To assess the diagnostic performance of response assessment 18F-fluorodeoxyglucose positron emission tomography/contrast-enhanced computed tomography (FDG-PET/CECT) following definitive radio(chemo)therapy in head and neck squamous cell carcinoma (HNSCC) using Neck Imaging Reporting and Data System (NI-RADS).

STUDY DESIGN

A retrospective analysis from a prospectively maintained dataset.

SETTING

Tertiary-care comprehensive cancer center in a low-middle-income country.

METHODS

Adults with newly diagnosed, biopsy-proven, nonmetastatic HNSCC treated with definitive radio(chemo)therapy were included. Posttreatment response assessment FDG-PET/CECT scans were retrospectively assigned NI-RADS categories (1-3) for the primary site, neck, and both sites combined. Locoregional recurrence occurring within 2-years was defined as the event of interest. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated. Locoregional control stratified by NI-RADS categories was computed with the Kaplan-Meier method and compared using the log-rank test.

RESULTS

Posttreatment FDG-PET/CECT scans were available in 190 patients constituting the present study cohort. Sensitivity, specificity, PPV, NPV, and overall accuracy of the NI-RADS template for the primary site was 73.5%, 81.4%, 46.3%, 93.4%, and 80.0%, respectively. Similar metrics for the neck were 72.7%, 87.5%, 43.2%, 96.1%, and 85.8%, respectively. Combining primary site and neck, the corresponding metrics of diagnostic accuracy were 84.4%, 69.7%, 46.3%, 93.5%, and 73.2%, respectively. At a median follow-up of 40 months, Kaplan-Meier estimates of 2-year locoregional control were significantly higher for NI-RADS category 1 (94.2%) compared to NI-RADS category 2 (69.4%) and category 3 (20.4%), respectively (stratified log-rank p < .0001).

CONCLUSION

FDG-PET/CECT using the NI-RADS template is associated with good diagnostic performance and prognostic utility in HNSCC treated with definitive radio(chemo)therapy.

摘要

目的

使用颈部成像报告和数据系统（NI-RADS）评估头颈部鳞状细胞癌（HNSCC）根治性放化疗后 18F-氟脱氧葡萄糖正电子发射断层扫描/对比增强计算机断层扫描（FDG-PET/CECT）的诊断性能。

研究设计

从前瞻性维护的数据集进行回顾性分析。

设置

在中低收入国家的三级保健综合癌症中心。

方法

纳入经新诊断、经活检证实、未经转移性 HNSCC 治疗的成年人，接受根治性放化疗。回顾性地为原发性部位、颈部和两个部位的 FDG-PET/CECT 扫描分配 NI-RADS 类别（1-3）。2 年内发生的局部区域复发定义为感兴趣的事件。计算灵敏度、特异性、阳性预测值（PPV）、阴性预测值（NPV）和总准确率。使用 Kaplan-Meier 方法计算并使用对数秩检验比较 NI-RADS 类别分层的局部区域控制。

结果

190 名患者的 FDG-PET/CECT 扫描可用于本研究队列。原发性部位的 NI-RADS 模板的灵敏度、特异性、PPV、NPV 和总准确率分别为 73.5%、81.4%、46.3%、93.4%和 80.0%。颈部的相似指标分别为 72.7%、87.5%、43.2%、96.1%和 85.8%。将原发性部位和颈部结合起来，诊断准确性的相应指标分别为 84.4%、69.7%、46.3%、93.5%和 73.2%。在中位随访 40 个月时，NI-RADS 类别 1（94.2%）的 2 年局部区域控制的 Kaplan-Meier 估计明显高于 NI-RADS 类别 2（69.4%）和类别 3（20.4%）（分层对数秩 p <.0001）。