Virili Florencia, Obermair Andreas, Sanjida Saira, Nicklin James L, Garrett Andrea, Land Russell, Tang Amy, Campbell Louise, Gebski Val, Thomas Paul
Sanatorio de la Trinidad San Isidro, San Isidro, Argentina.
Sanatorio Anchorena, Buenos Aires, Argentina.
Int J Gynecol Cancer. 2025 Jan 6. doi: 10.1136/ijgc-2024-005633.
Imaging for staging ovarian cancer is important to determine the extent of disease. The primary objective of this study was to compare gated 18F-fluorodeoxyglucose positron emission tomography coupled with computed tomography (FDG PET/CT) and standard CT scan with intravenous contrast to diagnose thoracic involvement in patients with advanced ovarian cancer prior to treatment. The secondary objective was to estimate changes in the International Federation of Gynecology and Obstetrics (FIGO) stage and clinical management resulting from gated PET/CT.
The IMAGE trial is a non-randomized phase II clinical trial comparing standard CT scanning with gated PET/CT in diagnosing thoracic involvement in a non-selected group of patients with suspected ovarian cancer on a contrast CT scan. Three sets of PET images were obtained comprising an ungated 2 min whole body image, a static 7.5 min image of the upper abdomen and thorax, and a gated end-expiratory image over the upper abdomen and thorax. Images were evaluated for specificity, sensitivity, diagnostic accuracy, and the proportion of patients with changes in FIGO stage and subsequent clinical management was compared between imaging techniques.
A total of 84 patients were enrolled based on a standard CT scan, 67 of whom were eligible for gated PET/CT scans. Diagnostic accuracy with gated PET/CT was more than 80% for lesions in lung, liver, extra-abdominal sites, and pleura, but less than 50% for extra-abdominal lymph nodes. Compared with CT scan at baseline, 46% of patients who had 7.5 min gated PET/CT had disease upstaged from stage III to IV, and 8% had disease downstaged from stage IV to III. However, this led to a change of management in only 5% of patients.
Gated PET/CT enables upstaging; however, in our institution it altered clinical management only in a minority of patients.
NCT02258165.
对卵巢癌进行分期的影像学检查对于确定疾病范围很重要。本研究的主要目的是比较门控18F-氟脱氧葡萄糖正电子发射断层扫描与计算机断层扫描（FDG PET/CT）和静脉注射造影剂的标准CT扫描，以诊断晚期卵巢癌患者治疗前的胸部受累情况。次要目的是评估门控PET/CT对国际妇产科联盟（FIGO）分期和临床管理的影响。
IMAGE试验是一项非随机II期临床试验，比较标准CT扫描与门控PET/CT在诊断一组经增强CT扫描怀疑患有卵巢癌的非特定患者的胸部受累情况。获得了三组PET图像，包括非门控2分钟全身图像、上腹部和胸部的静态7.5分钟图像以及上腹部和胸部的门控呼气末图像。对图像进行特异性、敏感性、诊断准确性评估，并比较成像技术之间FIGO分期改变的患者比例以及后续临床管理情况。
基于标准CT扫描共纳入84例患者，其中67例符合门控PET/CT扫描条件。门控PET/CT对肺、肝、腹外部位和胸膜病变的诊断准确性超过80%，但对腹外淋巴结的诊断准确性低于50%。与基线CT扫描相比，进行7.5分钟门控PET/CT检查的患者中有46%的疾病分期从III期升至IV期，8%的疾病分期从IV期降至III期。然而，这仅导致5%的患者临床管理发生改变。
门控PET/CT可使分期升高；然而，在我们机构中，它仅使少数患者的临床管理发生改变。
NCT02258165。
