Diagnostic performance of nanoparticle-enhanced magnetic resonance Imaging in the diagnosis of lymph node metastases in patients with endometrial and cervical cancer
Diagnostic performance of nanoparticle-enhanced magnetic resonance Imaging in the diagnosis of lymph node metastases in patients with endometrial and cervical cancer
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DOI：
10.1200/jco.2005.07.166
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发表时间：
2005-04-20
影响因子：
45.3
通讯作者：
Reznek, RH
中科院分区：
文献类型：
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作者：
Rockall, AG;Sohaib, SA;Reznek, RH
淋巴结转移影响妇科恶性肿瘤患者的治疗和预后。术前用计算机断层扫描或磁共振成像（MRI）进行淋巴结评估是不准确的。一种新的淋巴结特异性造影剂ferumoxtran-10，由超小氧化铁颗粒（USPIO）组成，可以增强淋巴结转移的检测，与淋巴结大小无关。我们的目的是比较MRI与USPIO对标准大小criterions.Methods子宫内膜癌（n = 15）或宫颈癌（n = 29）的诊断性能。在USPIO给药前后进行MRI检查。两名独立观察员在淋巴结取样前查看MR图像。结果淋巴结标本提供了768个盆腔或腹主动脉旁淋巴结供病理检查，其中335个在MRI上有相关性，44例患者中11例（25%）发现17个恶性淋巴结。在逐淋巴结的基础上，按大小标准计算的灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为29%*、99%、56%和96%，根据USPIO标准（阅片人1/阅片人2）分别为93%/82%*（*P = 008/ 004）97%/97%、61%/59%和100%/99%，其中[*]表示星号标记的两个结果之间的P = x/x的统计学差异。在逐个患者的基础上，按尺寸标准的灵敏度、特异性、PPV和NPV分别为27%*、94%、60%和79%，按USPIO标准（阅片人1/阅片人2）分别为100%/91%*（*P = 0.031/0.06）、94%/87%、82%/71%和100%/96%。Kappa值为0.93。结论采用USPIO进行淋巴结定征可提高MRI预测淋巴结转移的敏感性，且不损失特异性。这可以大大改善术前治疗计划。
Purpose Lymph node metastases affect management and prognosis of patients with gynecologic malignancies. Preoperative nodal assessment with computed tomography or magnetic resonance imaging (MRI) is inaccurate. A new lymph node-specific contrast agent, ferumoxtran-10, composed of ultrasmall particles of iron oxide (USPIO), may enhance the detection of lymph node metastases independent of node size. Our aim was to compare the diagnostic performance of MRI with USPIO against standard size criteria.Methods Forty-four patients with endometrial (n = 15) or cervical (n = 29) cancer were included. MRI was performed before and after administration of USPIO. Two independent observers viewed the MR images before lymph node sampling. Lymph node metastases were predicted using size criteria and USPIO criteria Lymph node sampling was performed in all patients.Results Lymph node sampling provided 768 pelvic or para-aortic nodes for pathology, of which 335 were correlated on MRI; 17 malignant nodes were found in 11 of 44 patients (25 %). On a node-by-node basis, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) by size criteria were 29 %*, 99 %, 56 %, and 96 %, and by USPIO criteria (reader 1/reader 2) were 93 %/82 %* (*P = 008/ 004) 97 %/97 % 61 %/59 % and 100 %/99 %, respectively (where [*] indicates the statistical difference of P = x/x between the two results marked by the asterisk). On a patient-by-patient basis, sensitivity, specificity, PPV, and NPV by size criteria were 27 %*, 94 %, 60 %, and 79 %, and by USPIO criteria (reader 1/reader 2) were 100 %/91 %* (*P = .031/.06), 94 %/87 %, 82 %/71 %, and 100 %/ 96 %, respectively. The kappa statistic was 0.93.Conclusion Lymph node characterization with USPIO increases the sensitivity of MRI in the prediction of lymph node metastases, with no loss of specificity. This may greatly improve preoperative treatment planning.