目的:透析患者发生肾细胞癌(RCC)的风险增加;然而,使用模式区分RCC和良性囊肿有时可能很困难,如计算机断层扫描(CT)和超声检查。18F-氟脱氧葡萄糖正电子发射断层扫描(FDG-PET)/CT可有效检测恶性肿瘤;然而,FDG在肾脏中的生理积累限制了其检测肾脏肿瘤的功效。然而,在肾功能严重受损的患者中,肾脏的FDG积累减少,可能会改善该患者人群中肾脏恶性肿瘤的检测。这项研究评估了FDG-PET/CT作为检测终末期肾病患者RCC的筛查工具的有用性。
方法:这项前瞻性研究招募了2012年至2016年的150名参与者,他们正在接受透析或接受肾移植,并在接受透析直至移植。行FDG-PET/CT筛查RCC。三名放射科医生独立评估图像。没有为阳性检查的额外管理定义方案,让每个参与者自行决定。观察到阴性检查,直到2019年底。
结果:总计,150名参与者(平均年龄,58±13岁;105名男性)接受FDG-PET/CT检查。20例患者(13.4%)诊断为阳性。15名患者接受了额外的检查和/或手术,在7例患者中发现了RCC。在接受手术切除的四名患者中,病理结果为透明细胞肾细胞癌,乳头状RCC在一个,和获得性囊性疾病相关性肾癌。两名参与者在骨活检中被诊断为RCC,1例动态CT诊断,但选择观察。敏感性,特异性,阴性预测值为100%,93.9%,100%,分别。
结论:FDG-PET/CT可用于检测终末期肾病患者的RCC。我们的研究结果表明,在该患者人群中,FDG-PET/CT可能用作RCC的筛查工具。
OBJECTIVE: Dialysis patients are at an increased risk of developing renal cell carcinoma (RCC); however, differentiating between RCC and benign cysts can sometimes be difficult using modalities, such as computed tomography (CT) and ultrasonography. 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET)/CT efficiently detects malignant tumors; however, physiological accumulation of FDG in the kidney limits its efficacy in detecting renal tumors. However, in patients with severely impaired renal function, the renal accumulation of FDG is decreased, possibly improving the detection of renal malignancies in this patient population. This study evaluated the usefulness of FDG-PET/CT as a screening tool for detecting RCC in patients with end-stage renal disease.
METHODS: This prospective study recruited 150 participants from 2012 to 2016 who were on dialysis or underwent renal transplantation and were on dialysis until transplantation. FDG-PET/CT was performed to screen for RCC. Three radiologists independently evaluated the images. No protocol was defined for the additional management of positive examinations, leaving decisions to the discretion of each participant. Negative examinations were observed until the end of 2019.
RESULTS: In total, 150 participants (mean age, 58 ± 13 years; 105 men) underwent FDG-PET/CT. Twenty patients (13.4%) were diagnosed as positive. Fifteen patients underwent additional examinations and/or procedures, and RCC was found in seven patients. Of the four patients who underwent surgical resection, the pathological results were clear cell RCC in one, papillary RCC in one, and acquired cystic disease-associated RCC in two. Two participants were diagnosed with RCC on bone biopsy, and one was diagnosed on dynamic CT but opted for observation. The sensitivity, specificity, and negative predictive value were 100%, 93.9%, and 100%, respectively.
CONCLUSIONS: FDG-PET/CT was useful for detecting RCC in patients with end-stage renal disease. Our findings show the potential use of FDG-PET/CT as a screening tool for RCC in this patient population.