目的:探讨肛门鳞状细胞癌CT基线分期的差异,MRI,PET/CT,以及由此对辐射计划的影响。
方法:这项回顾性研究包括连续接受盆腔MRI检查的肛门鳞状细胞癌患者,CT,2010年1月至2020年4月,PET/CT(所有检查均在3周内进行)。CT,核磁共振,和PET/CT由三个独立的放射科医师重新解释。评估了几种影像学特征;根据美国癌症联合委员会(AJCC)第八版分期手册确定肿瘤分期;和T(肿瘤),N(节点),根据国家综合癌症网络(NCCN)指南确定M(转移)类别。然后将放射科医生的评估随机提供给放射肿瘤学家,后者以盲目的方式制定了放射计划。
结果:共有28名患者(中位年龄,62年[范围,31-78],与MRI和CT相比,PET/CT的T类别分类显着不同(分别为p=0.037和0.031)。PET/CT分期的T1/T2病发患者比例(16/28,57%)较MRI(11/28,39%)和CT(10/28,36%)高。MRI分期的T3/T4病发患者比例(14/28,50%)较CT(12/28,43%)和PET/CT(11/28,39%)高。然而,这三种成像模式在任一N类方面都没有显着差异,AJCC分期,或NCCNTNM组分类,或治疗计划。
结论:我们的探索性研究表明,MRI显示T3/T4肿瘤的比例更高,虽然PET/CT显示更多的T1/T2肿瘤;然而,MRI,CT,PET/CT在AJCC和TNM组类别中没有显示任何显着差异,由经验丰富的放射肿瘤科医师独立评估时,两者在治疗剂量上也没有任何显著差异.
To investigate the differences in baseline staging of anal squamous cell carcinoma based on CT, MRI, and PET/CT, and the resultant impact on the radiation plan.
This retrospective study included consecutive patients with anal squamous cell carcinoma who underwent baseline pelvic MRI, CT, and PET/CT (all examinations within 3 weeks of each other) from January 2010 to April 2020. CTs, MRIs, and PET/CTs were re-interpreted by three separate radiologists. Several imaging features were assessed; tumor stage was determined based on the eight edition of the American Joint Committee on Cancer (AJCC) staging manual; and T (tumor), N (node), and M (metastasis) categories were determined based on National Comprehensive Cancer Network (NCCN) guidelines. Radiologist assessments were then randomly presented to a radiation oncologist who formulated the radiation plan in a blinded fashion.
Across 28 patients (median age, 62 years [range, 31-78], T-category classification was significantly different on PET/CT compared to MRI and CT (p = 0.037 and 0.031, respectively). PET/CT staged a higher proportion of patients with T1/T2 disease (16/28, 57%) compared to MRI (11/28, 39%) and CT (10/28, 36%). MRI staged a higher proportion of patients with T3/T4 disease (14/28, 50%) compared to CT (12/28, 43%) and PET/CT (11/28, 39%). However, there was no significant difference between the three imaging modalities in terms of either N-category, AJCC staging, or NCCN TNM group classification, or in treatment planning.
Our exploratory study showed that MRI demonstrated a higher proportion of T3/T4 tumors, while PET/CT demonstrated more T1/T2 tumors; however, MRI, CT, and PET/CT did not show any significant differences in AJCC and TNM group categories, nor was there any significant difference in treatment doses between them when assessed independently by an experienced radiation oncologist.