目的:局部晚期宫颈癌(LACC)的治疗涉及盆腔放化疗,在主动脉旁受累的情况下使用扩展视野。18-Fluoro-D-葡萄糖正电子发射断层扫描与计算机断层扫描(PET-CT)相结合是检测转移性淋巴结的准确方法。这项研究的目的是评估PET-CT在LACC淋巴结分期中的表现。
方法:这项双中心回顾性研究包括2015年1月至2019年12月期间接受PET-CT扫描并进行主动脉旁淋巴结清扫术的LACC患者。根据病理结果,灵敏度,特异性,负预测值(NPV),评估了PET-CT对主动脉旁淋巴结受累的阳性预测值(PPV)和假阴性(FN)率.
结果:本研究纳入了71例接受腹腔镜淋巴结清扫术的患者。术中并发症发生率为2.8%。灵敏度,特异性,PET-CT的NPV和PPV为55%[95%置信区间(CI)44.6-67.1],84%(95%CI75-92),93%(95%CI87-99)和33%(95%CI22-44),分别。骨盆PET-CT阴性或阳性的FN率分别为5.7%和9.5%,分别。
结论:在主动脉旁PET-CT阴性的情况下,推荐主动脉旁淋巴结清扫术用于淋巴结分期。鉴于PET-CT的FN率低,如果患者存在高手术风险,无论骨盆状况如何,都应讨论手术分期,或者如果这延迟了放化疗的开始。
OBJECTIVE: Treatment of locally advanced cervical cancer (LACC) involves pelvic chemoradiotherapy, using an extended field in the case of para-aortic involvement. 18-Fluoro-D-glucose positron emission tomography combined with computer tomography (PET-CT) is an accurate method for the detection of metastatic nodes. The objective of this study was to evaluate the performance of PET-CT for lymph node staging of LACC.
METHODS: This bicentric retrospective study included patients with LACC who had a PET-CT scan followed by para-aortic lymphadenectomy between January 2015 and December 2019. Based on pathological findings, sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and false-negative (FN) rates of PET-CT for para-aortic node involvement were evaluated.
RESULTS: Seventy-one patients who had undergone laparoscopic lymphadenectomy were included in this study. The intraoperative complication rate was 2.8%. Sensitivity, specificity, NPV and PPV for PET-CT were 55% [95% confidence interval (CI) 44.6-67.1], 84% (95% CI 75-92), 93% (95% CI 87-99) and 33% (95% CI 22-44), respectively. FN rates in the case of negative or positive pelvic PET-CT were 5.7% and 9.5%, respectively.
CONCLUSIONS: Para-aortic lymphadenectomy is recommended for lymph node staging in the case of negative para-aortic PET-CT. In view of the low FN rate of PET-CT, surgical staging should be discussed regardless of pelvic status if the patient presents high surgical risk, or if this delays the commencement of chemoradiotherapy.