Utility of PET/CT to Evaluate Retroperitoneal Lymph Node Metastasis in High-Risk Endometrial Cancer: Results of ACRIN 6671/GOG 0233 Trial
Utility of PET/CT to Evaluate Retroperitoneal Lymph Node Metastasis in High-Risk Endometrial Cancer: Results of ACRIN 6671/GOG 0233 Trial
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DOI：
10.1148/radiol.2016160200
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发表时间：
2017-05-01
期刊：
影响因子：
19.7
通讯作者：
Gold, Michael
中科院分区：
文献类型：
--
作者：
Atri, Mostafa;Zhang, Zheng;Gold, Michael
目的：为了评估氟18氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）结合诊断造影剂增强计算机断层扫描（CT）在检测淋巴结（LN）转移在高危endometrial cancer.Materials和Methods：这一前瞻性多中心符合健康保险及责任法案的研究机构审查委员会批准，所有参与者给予书面知情同意。数据是2010年1月至2013年6月期间累积的。患者接受PET/CT和盆腔和腹部淋巴结清扫术。215例入组患者中有207例有腹部和骨盆的PET/CT和病理检查结果。平均患者年龄为62.7岁6 9.6（标准差）。本中心阅片人研究使用了所有23例腹部检查阳性患者和26例随机选择的腹部检查阴性患者的数据。七名独立盲读医师在间隔1个月的不同会议上审查了诊断CT和PET/CT结果。在参与者水平计算准确性，将腹部（右侧和左侧主动脉旁和髂总动脉）和盆腔（右侧和左侧髂外动脉和闭孔肌）LN区域与病理结果相关联，并考虑偏侧性。比较PET/CT和诊断CT的阅片者平均灵敏度、特异性和受试者工作特征曲线下面积（AUC）。结果：PET/CT与CT诊断LN转移的敏感性分别为0.65（95%置信区间[CI]：0.57，0.72）与0.50（95% CI：0.43，0.58）（P= 0.01），骨盆为0.65（95% CI：0.57，0.72）vs 0.48（95% CI：0.41，0.56）（P= 0.004）。特异性为0.88（95% CI：0.83，0.92）vs 0.93（95% CI：0.89，0.96）（P= 0.11）和0.93（95% CI：0.86，0.96）vs 0.89（95% CI：0.82，0.94）（P=.27），AUC为0.78（95% CI：0.66，0.89）vs 0.74（95% CI：0.63，0.86）（P= 0.39）和0.82（95% CI：0.71，0.92）vs 0.73结论：FDGPET/CT对高危子宫内膜癌腹腔淋巴结转移的诊断准确性较高。与单独的诊断性CT相比，在诊断性CT中添加PET显著增加了腹部和骨盆的灵敏度，同时保持了高特异性。
Purpose: To assess the diagnostic accuracy of fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) combined with diagnostic contrast material-enhanced computed tomography (CT) in detecting lymph node (LN) metastasis in high-risk endometrial cancer.Materials and Methods: This prospective multicenter HIPAA-compliant study had institutional review board approval, and all participants gave written informed consent. Data were accrued between January 2010 and June 2013. Patients underwent PET/CT and pelvic and abdominal lymphadenectomy. Two hundred seven of 215 enrolled patients had PET/CT and pathologic examination results for the abdomen and pelvis. Mean patient age was 62.7 years 6 9.6 (standard deviation). Data in all 23 patients with a positive abdominal examination and in 26 randomly selected patients with a negative abdominal examination were used for this central reader study. Seven independent blinded readers reviewed diagnostic CT and PET/CT results in different sessions 1 month apart. Accuracy was calculated at the participant level, correlating abdominal (right and left para-aortic and common iliac) and pelvic (right and left external iliac and obturator) LN regions with pathologic results, respecting laterality. Reader-average sensitivities, specificities, and areas under the receiver operating characteristic curve (AUCs) of PET/CT and diagnostic CT were compared. Power calculation was for sensitivity and specificity in the abdomen.Results: Sensitivities of PET/CT versus diagnostic CT for the detection of LN metastasis were 0.65 (95% confidence interval [CI]: 0.57, 0.72) versus 0.50 (95% CI: 0.43, 0.58) (P=.01) in the abdomen and 0.65 (95% CI: 0.57, 0.72) versus 0.48 (95% CI: 0.41, 0.56) (P=.004) in the pelvis. Corresponding specificities were 0.88 (95% CI: 0.83, 0.92) versus 0.93 (95% CI: 0.89, 0.96) (P=.11) and 0.93 (95% CI: 0.86, 0.96) versus 0.89 (95% CI: 0.82, 0.94) (P=.27), and AUCs were 0.78 (95% CI: 0.66, 0.89) versus 0.74 (95% CI: 0.63, 0.86) (P=.39) and 0.82 (95% CI: 0.71, 0.92) versus 0.73 (95% CI: 0.63, 0.84) (P=.02).Conclusion: FDG PET/CT has satisfactory diagnostic accuracy in the detection of abdominal LN metastasis in high-risk endometrial cancer. Compared with diagnostic CT alone, addition of PET to diagnostic CT significantly increased sensitivity in both the abdomen and pelvis while maintaining high specificity.