背景:FDG-PET/CT是一种非侵入性检查,可能有助于子宫内膜癌的治疗。这项研究的目的是评估FDG-PET/CT在评估高危子宫内膜癌主动脉旁淋巴结受累中的表现。
方法:我们在2009年至2019年间进行了一项回顾性多中心研究,包括所有患有高危子宫内膜癌的患者,术前进行了FDG-PET/CT和主动脉旁淋巴结切除术(PAL)。主要目的是评估FDG-PET/CT的整体性能。次要目标是根据组织学类型和FDG-PET/CT日期(子宫切除术前或后)评估其表现,并将其整体性能与MRI扫描进行比较。
结果:我们纳入了来自六个不同中心的200名患者。核医师重读FDG-PET/CT假阳性后,FDG-PET/CT的灵敏度为61.8%,特异性为89.7%,阳性预测值为69.4%,阴性预测值为86.1%,AUC为0.76。根据组织学类型和FDG-PET/CT日期,性能无统计学差异。FDG-PET/CT的敏感性优于MRI(p<0.01),但特异性不是(p=0.82).
结论:目前,单独的FDG-PET/CT不能代替PAL用于高危子宫内膜癌的淋巴结评估。在验证患者的治疗管理之前,在多学科会议上重新阅读它似乎是必要的,特别是在孤立的主动脉旁受累的情况下。
BACKGROUND: FDG-PET/CT is a noninvasive examination that could be helpful for the management of endometrial cancer. The aim of this
study was to evaluate the performance of FDG-PET/CT in assessing para-aortic lymph-node involvement in high-risk endometrial cancer.
METHODS: We performed a retrospective multicenter
study including all patients who had a high-risk endometrial cancer with a preoperative FDG-PET/CT and a para-aortic lymphadenectomy (PAL) between 2009 and 2019. The main objective was to evaluate the overall performance of FDG-PET/CT. The secondary objectives were to evaluate its performances according to the histological type and according to FDG-PET/CT date (before or after hysterectomy), and to compare its overall performance with that of the MRI scan.
RESULTS: We included 200 patients from six different centers. After the false positive FDG-PET/CT was reread by nuclear physicians, FDG-PET/CT had a sensitivity of 61.8%, a specificity of 89.7%, a positive predictive value of 69.4%, a negative predictive value of 86.1%, and an AUC of 0.76. There were no statistically significant differences in the performances according to either histological type and or FDG-PET/CT date. The sensitivity of FDG-PET/CT was better than that of MRI (p < 0.01), but the specificity was not (p = 0.82).
CONCLUSIONS: Currently, FDG-PET/CT alone cannot replace PAL for the lymph node evaluation of high-risk endometrial cancers. It seems essential to reread it in multidisciplinary meetings before validating the therapeutic management of patients, particularly in the case of isolated para-aortic involvement.