Clinical utility of indium 111-capromab pendetide immunoscintigraphy in the detection of early, recurrent prostate carcinoma after radical prostatectomy

BACKGROUND: Despite the ability of radical prostatectomy to eradicate prostate carcinoma, biochemical evidence of recurrent prostate carcinoma may be seen in approximately 40% of patients 15 years after they undergo surgery. Localization of recurrent disease after radical prostatectomy is difficult and may greatly influence subsequent clinical management. The authors examined the utility of indium 111 ((111)In)-capromab pendetide immunoscintigraphy to detect recurrent prostate carcinoma radiographically in men with early biochemical evidence of failure (serum prostate specific antigen [PSA] < or = 4.0 ng/mL) and assessed the minimum serum PSA level necessary for imaging recurrent disease. METHODS: Between May 1987 and August 1995, 255 hormone-na?ve men with a mean (+/- standard deviation) age of 65 years +/- 7 years who underwent radical prostatectomy for clinically localized prostate carcinoma were followed without adjuvant therapy until early PSA recurrence in this multicenter study. Preoperatively, all patients had negative bone scans and pathologically negative lymph nodes, and they did not undergo hormonal ablation, chemotherapy, or radiation therapy preoperatively or postoperatively until the (111)In-capromab pendetide scan was performed. All men in this study had postoperative serum PSA levels < or = 4.0 ng/mL at the time of radionuclide imaging. All men underwent imaging with the capromab pendetide scan to localize recurrent disease, and charts were reviewed to document clinical evidence of recurrence. RESULTS: Pathologic findings included mean Gleason scores of 6.7 +/- 1.2; pathologic tumors classified as pT2a (18%), pT2b (26%), pT3a (38%), pT3b (16%), and pT4a (2%); a pathologic lymph node status of pN0 (100%); positive surgical margins (44%); and perineural invasion (42%). Capromab pendetide uptake was seen in 72% of 255 men throughout a range of patients' postoperative serum PSA levels (0.1-4.0 ng/mL), with 31% of men having local uptake (prostatic fossa) only. Of 151 men who underwent additional imaging studies, 16 of 139 men (12%) and 15 of 92 men (16%) showed evidence of recurrent disease by bone scintigraphy and computed tomography scans, respectively. Gleason score, pathologic stage, perineural invasion, and margin status were not correlated significantly with the (111)In-capromab pendetide scan. CONCLUSIONS: Capromab pendetide imaging can localize early PSA recurrence and may guide appropriate treatment after patients undergo radical prostatectomy. No minimum serum PSA value was needed to potentially detect radiographic disease after surgery. Further confirmatory studies and long-term follow-up of this cohort documenting response to salvage therapy are needed to validate these imaging findings.     

Indium-111-capromab pendetide radioimmunoscintigraphy and prognosis for durable biochemical response to salvage radiation therapy in men after failed prostatectomy.

PURPOSE: We evaluated the prognostic significance of indium-111 (111In)-capromab pendetide imaging for patients with prostate cancer who underwent salvage radiotherapy (RT) for recurrent disease after prostatectomy. PATIENTS AND METHODS: Records were reviewed for all men who underwent 111In-capromab pendetide imaging at a single institution from February 1997 through December 1999. We identified 30 eligible men who were radiographically negative for metastatic disease, who had increasing serum prostate-specific antigen (PSA) after primary radical prostatectomy, and who received salvage RT. Clinical interpretations of indium monoclonal antibody (In-mab) scan results were compared with postsalvage RT PSA response. RESULTS: Using an American Society of Therapeutic Radiation and Oncology definition of PSA failure, in men with a positive scan in at least one location (n = 14), the cumulative 2-year PSA control after salvage RT was 0.38 +/- 0.13 (+/- SE) compared with 0.31 +/- 0.13 for men with a normal antibody scan in and outside the prostate fossa (n = 15; proportional hazard ratio [PHR] = 1.32; 95% confidence interval [CI], 0.52 to 3.36). For men with a positive antibody scan limited to the prostate fossa (n = 9), PSA control at 2 years was 0.13 +/- 0.12 (PHR 1.77; 95% CI, 0.65 to 4.85). The 2-year probability of PSA control after salvage RT for men with positive scan results outside the prostate bed irrespective of In-mab findings in the prostate fossa (n = 5) was 0.60 +/- 0.22 (PHR 0.81; 95% CI, 0.17 to 3.78). CONCLUSION: In contrast to previous reports, for patients with postprostatectomy biochemical relapse who received salvage RT, presalvage RT In-mab scan findings outside the prostate fossa were not predictive of biochemical control after RT.     

Lymphatic and vascular embolizations are independent predictive variables of inguinal lymph node involvement in patients with squamous cell carcinoma of the penis: Gruppo Uro-Oncologico del Nord Est (Northeast Uro-Oncological Group) Penile Cancer data base data

BACKGROUND: The objective of the current study was to identify independent clinical and pathologic variables that were predictive of lymph node involvement in patients with squamous cell carcinoma of the penis in a multicenter series with the intent to select patients who were suitable to undergo immediate inguinal lymphadenectomy. METHODS: Data were analyzed from 175 patients who underwent surgery for penile carcinoma in 11 urologic centers participating in the Gruppo Uro-Oncologico del Nord-Est (Northeast Uro-Oncological Group) Penile Cancer Data Base. Pathologically positive lymph nodes were defined as the presence of histologically confirmed lymph node metastasis in patients who underwent either immediate or delayed inguinal and/or pelvic lymphadenectomy. Patients who had clinically positive lymph nodes with cytologically positive fine-needle aspiration results and who had not undergone lymphadenectomy were censored. RESULTS: Overall, lymph-node involvement was observed in 71 of 175 patients (40.6%) included in the analyses. After analyzing the whole group of patients, the following variables were identified as independent predictors of pathologic lymph node metastasis: clinical lymph node status, pathologic stage of the primary tumor, venous and lymphatic embolizations, and histologic grade. In the subgroup of patients with clinically negative lymph nodes, tumor thickness, histologic grade, lymphatic and venous embolizations, infiltration of both corpus spongiosum and urethra, and pathologic stage of the primary tumor (according to the 1997 TNM classification system) were predictive of lymph node involvement on univariate analysis. The generated logistic regression model showed that venous and/or lymphatic embolizations and infiltration of the corpus spongiosum and/or urethra were independent predictors of pathologic lymph node metastasis in patients with clinically negative lymph nodes. CONCLUSIONS: Venous and/or lymphatic embolizations played relevant roles as predictors of pathologic lymph node involvement in patients with penile neoplasia and should be considered important parameters in determining which patients with clinically negative lymph nodes should undergo immediate lymphadenectomy.     

Long-term follow-up of 111In-capromab pendetide (ProstaScint) scan as pretreatment assessment in patients who undergo salvage radiotherapy for rising prostate-specific antigen after radical prostatectomy for prostate cancer

PURPOSE: To evaluate the long-term failure patterns in patients who underwent an (111)In-capromab pendetide (ProstaScint) scan as part of their pretreatment assessment for a rising prostate-specific antigen (PSA) level after prostatectomy and subsequently received local radiotherapy (RT) to the prostate bed. METHODS: Fifty-eight patients were referred for evaluation of a rising PSA level after radical prostatectomy. All patients had negative findings for metastatic disease after abdominal/pelvis imaging with CT and isotope bone scans. All patients underwent a capromab pendetide scan, and the sites of uptake were noted. All patients were treated with local prostate bed RT (median dose 66.6 Gy). RESULTS: Of the 58 patients, 20 had biochemical failure (post-RT PSA level >0.2 ng/mL or a rise to greater than the nadir PSA), including 6 patients with positive uptake outside the bed (positive elsewhere). The 4-year biochemical relapse-free survival (bRFS) rates for patients with negative (53%), positive in the prostate bed alone (45%), or positive elsewhere (74%) scan findings did not differ significantly (p = 0.51). The positive predictive value of the capromab pendetide scan in detecting disease outside the bed was 27%. The capromab pendetide scan status had no effect on bRFS. Those with a pre-RT PSA level of <1 ng/mL had improved bRFS (p = 0.003). CONCLUSION: The capromab pendetide scan has a low positive predictive value in patients with positive elsewhere uptake and the 4-year bRFS was similar to that for those who did not exhibit positive elsewhere uptake. Therefore, patients with a postprostatectomy rising PSA level should considered for local RT on the basis of clinicopathologic factors.     

术前CT检查在可手术非小细胞肺癌TNM分期中的应用评价

目的比较术前CT检查和术后病理诊断的非小细胞肺癌TNM分期结果,评价术前CT检查对非小细胞肺癌TNM分期的临床参考价值。方法112例临床确诊为NSCLC的患者行术前螺旋CT检查,临床分期为Ⅰ～ⅢA患者行手术切除加系统性淋巴结清扫,术前CT检查对TNM的分期结果定义为临床TNM（cTNM）,术后的病理分期定义为病理TNM（pTNM）。对比患者的cTNM与pTNM,评价术前CT检查确定非小细胞肺癌TNM分期的敏感度、特异性和准确率。结果（1）术前CT检查诊断T分期的敏感度和特异性分别为76.6％和85.7％,阳性预测值为92.2％,阴性预测值为62.5％,准确率为79.5％。一致性检验有统计学意义（Kappa=0.658,P<0.05）;（2）术前CT检查诊断纵隔淋巴结转移的敏感度和特异性分别为72.9％和84.9％,阳性预测值为84.3％,阴性预测值为73.8％,准确率为78.6％,一致性检验有统计学意义（Kappa=0.667,P<0.05）。螺旋CT检查诊断 4R、5、6 组纵隔淋巴结转移的准确率和特异性偏低,其中4R组淋巴结转移的假阳性和假阴性较高。结论术前CT检查对非小细胞肺癌TNM分期有重要的临床参考价值,但存在假阳性和假阴性,应结合其他检查手段如PET-CT或纵隔镜等提高术前TNM分期准确率。     

Caveolin-1 expression is a predictor of recurrence-free survival in pT2N0 prostate carcinoma diagnosed in Japanese patients

BACKGROUND: The authors previously identified elevated caveolin-1 expression in human prostate carcinoma and determined that caveolin-1 levels as detected by immunohistochemistry of radical prostatectomy specimens offered novel prognostic information. A higher incidence of caveolin-1 expression also was reported in African-American men compared with white men in the U.S. To explore these ethnic/racial differences in caveolin-1 expression further, the authors evaluated caveolin-1 expression as a predictive marker in Japanese men with prostate carcinoma. METHODS: Immunohistochemical staining with a caveolin-1 specific antibody was performed on routinely processed paraffin sections from 152 consecutively collected radical prostatectomy specimens. The mean patient age was 64.3 years (range, 49-74 years; median, 64.5 years) and the mean follow-up period was 49.5 months (range, 1.3-103.3 months; median, 48.2 months). Caveolin-1 immunoreactivity was evaluated in association with patient's age; preoperative prostate specific antigen level; clinical stage; and pathologic features including Gleason score, extraprostatic extension, status of surgical margins, seminal vesicle involvement, lymph node involvement, and time to disease progression after surgery. RESULTS: Positive caveolin-1 immunostaining was detected in 46 of the 152 tumors (30.3%) and was found to be associated significantly with a positive surgical margin (P = 0.022). A higher incidence of caveolin-1 expression tended to be found in patients with poorly differentiated tumors (Gleason score > 7, 6-7, and < 6, 35.0% vs. 34.9% vs. 20.4%, respectively) or in patients with extraprostatic extension versus those without extraprostatic extension (35.4% vs. 24.7%) or patients with lymph node involvement compared with those without lymph node involvement (50% vs. 29.5%), although these differences did not reach statistical significance (P = 0.100, P = 0.150, and P = 0.178, respectively, by the Spearman correlation test). Kaplan-Meier analysis revealed that increased caveolin-1 expression was associated with an increased risk of disease progression at 5 years (P = 0.0122 by the log-rank test). In patients with organ-confined (pT2N0) disease, univariate Cox proportional hazards regression analysis revealed that positive caveolin-1 expression was the only significant predictor of disease recurrence after radical prostatectomy (P = 0.011; hazards ratio = 4.75; and 95% confidence interval, 1.43-15.76). CONCLUSIONS: The results of the current study confirm that positive caveolin-1 expression is associated with clinical markers of disease progression and is predictive of poor clinical outcome after surgery in Japanese patients with pT2N0 prostate carcinoma.     

A phase II study of [90Y] yttrium-capromab pendetide in the treatment of men with prostate cancer recurrence following radical prostatectomy

There is currently no curative therapy for men who have disseminated prostate cancer following failed radical prostatectomy. The purpose of this trial was to investigate systemic radioimmunotherapy in these men. Eight patients with occult metastatic prostate cancer following radical prostatectomy as evidenced solely by a rising serum PSA and evidence of soft tissue lesions outside the prostatic fossa detected by an [111I]indiumcapromab pendetide scan received an infusion of 10 mg of capromab pendetide labeled with 9 mCi/m2 of [90Y]yttrium. Serum PSA was used to measure response rate. There were no complete or partial responses by PSA criteria. Significant unexpected bone marrow toxicity developed in the first 6 of 8 patients treated. The last two patients received co-infusion of edetate calcium disodium in an effort to decrease marrow suppression. In these two patients less marrow toxicity was seen. Repeat 111In-capromab pendetide scans were uninterpretable due to grossly altered whole-body biodistribution of the radioimmunoconjugate. Retrospective analysis of serial PSA values after closure of the study showed a decrease in the log slope PSA for seven of eight patients following radioimmunotherapy, with a statistically significant change in the mean log slope (p = 0.01). The clinical significance of this small but measurable change is uncertain. We conclude that radioimmunotherapy for occult metastatic prostate cancer using 90Y-capromab-pendetide at the dose described does not lower serum PSA, is associated with significant hematologic toxicity, and leads to complexation of the immunoconjugate following subsequent capromab pendetide infusion.     

超声内镜在食管癌TN分期中的应用

目的评价超声内镜（EUS）对食管癌术前TN分期的准确性。方法40例食管癌患者术前行超声内镜检查,与术后病理结果相对照。结果EUS对食管癌侵犯深度判断总的准确性为85%。对是否有区域淋巴结转移判断的准确性为77.5%,敏感度为78.6%,特异性为76.9%,阳性预测值为64.7%,阴性预测值86.9%。结论EUS能较准确的判断食管癌TN分期,可作为术前治疗方法选择的重要依据。     

Prognostic significance of preoperative factors in localized prostate carcinoma treated with radical prostatectomy: importance of percentage of biopsies that contain tumor and the presence of biopsy perineural invasion

BACKGROUND: Predicting outcome for men with clinically localized prostate carcinoma treated with curative intent remains imprecise and further evaluation of accepted and potential predictive factors is needed. METHODS: The authors studied 696 men with localized prostate carcinoma diagnosed on transrectal biopsy and treated with radical prostatectomy at one institution between 1986 and 1999 to determine the relation between putative pretreatment prognostic factors and disease-free survival. Clinical stage, Gleason score, perineural invasion, number of biopsies containing tumor, and serum prostate specific antigen (PSA) were evaluated as predictors of extracapsular extension, seminal vesicle involvement, lymph node metastases, and surgical margin involvement as well as outcome after surgery. Kaplan-Meier method and Cox regression analyses were used to evaluate the contribution of different factors to adverse pathologic features and relapse. RESULTS: At mean follow-up of 56.9 months (range, 1.0-177.9 months; median, 54.9 months), 26.1% (182 of 696 patients) of patients had developed a disease recurrence. Pretreatment serum PSA concentration, biopsy Gleason score, and clinical stage as well as number of biopsies involved with tumor as a percentage of the total number obtained were found to be independent predictors of outcome. In patients with PSA > 10 ng/mL, biopsy perineural invasion and percentage of biopsies containing tumor were found to independently predicted disease recurrent. Increased number of biopsies involved with tumor independently predicted extracapsular extension, margin involvement, seminal vesicle, and lymph node involvement. CONCLUSIONS: This study demonstrated that the proportion of prostate biopsy cores containing tumor is an independent predictor of outcome after subsequent radical prostatectomy and suggested that perineural invasion has a predictive role in patients with a preoperative PSA > 10 ng/ml.     

高分辨3.0T磁共振评估直肠癌术前环周切缘有无累及的前瞻性研究

目的:探讨高分辨3.0T磁共振(magnetic resonance imaging,MRI)对直肠癌术前环周切缘(circumferential resection margin,CRM)有无累及的前瞻性评估,以指导直肠癌的多学科诊断和个体化治疗方式。方法:2012年2月至2017年7月利用GE 3.0T磁共振对46例经结肠镜证实的直肠癌患者进行盆腔磁共振平扫、DWI检查,常规序列包括失状位FRFSE T2WI、冠位FRFSE T2WI、轴位FRFSE T2WI和DWI,并且所有T2WI序列都采用小视野、薄层扫描,DWI的b值取1 000 s/mm2。然后综合所有序列对直肠癌病灶进行术前MRI-T、N分期判定,评估直肠系膜筋膜、环周切缘有无累及,然后与手术病理结果进行对照分析。结果:在46例直肠癌中,MRI-T分期中正确诊断40例,错误诊断6例,正确率为87.0%。N分期中正确诊断34例,错误诊断12例,正确率为73.9%。MRI判断直肠系膜环周切缘有无累及的准确率、敏感性、特异性、阳性预测值及阴性预测值分别为93.5%、100.0%、91.2%、80.0%及100.0%。结论:高分辨率3.0T磁共振成像可以对直肠癌手术环周切缘有无累及进行准确的预测,还可以清楚的显示病灶及邻近组织侵犯情况,指导直肠癌的个体化治疗。     

Disparity in pathologic and clinical lymph node staging in oral tongue carcinoma. Implication for therapeutic decision making

BACKGROUND: Regional lymph node metastasis is the most reliable predictor of treatment outcomes for patients with squamous cell carcinoma of the oral tongue (SCCOT). A recent American Joint Committee on Cancer staging update of malignant melanoma has incorporated pathologic lymph node staging. The authors hypothesized that pathologic lymph node staging (pN) would be a more reliable predictor of treatment outcomes than clinical lymph node staging (cN). METHODS: The authors retrospectively reviewed 266 patients who received primary surgical treatment for SCCOT, including a neck dissection, from January 1980 to December 1995. Overall and disease-specific survival and disease-free interval were compared with respect to clinical and pathologic lymph node stages. RESULTS: Statistically significant survival differences were identified for both clinical (cN0-cN2) and pathologic lymph node stages (pN0-pN2). However, survival and disease-free interval differences for pathologic lymph node staging reached higher statistical significance (P < 0.0001) than for clinical lymph node staging (P < 0.002). This disparity can be explained by stage migration (i.e., patients with cN0-1 disease have a more advanced lymph node stage at the time of pathologic review compared with patients without cN0-1 disease). The authors found a 34% rate of occult lymph node disease in the cN0 group (19% of occult lymph nodes had extracapsular spread [ECS]). Similarly, 43% of cN1 patients had a higher stage than pN2b disease and 50% had ECS. CONCLUSIONS: Pathologic lymph node staging, based on a staging or therapeutic neck dissection, should be considered for patients treated for SCCOT to identify high-risk patients who may benefit from additional adjuvant therapy. Prospective studies are essential to validate these findings before pathologic lymph node staging is included in standard staging criteria.     

子宫颈癌盆腔淋巴结转移的术前CT评价

目的：探讨螺旋CT检查对子宫颈癌盆腔淋巴结转移的诊断价值。方法：60例经临床及病理诊断为子宫颈癌的患者，做子宫颈癌根治术之前行盆腔螺旋CT检查，并以术后病理检查为金标准进行对照，按病例数和盆腔淋巴结部位(粒)数分别计算CT检查的灵敏度、特异度、Youden指数。结果：术前盆腔淋巴结螺旋CT检查的病例对照和部位对照的灵敏度分别为33．3％、28．6％，特异度分别为100％、98．8％，Youden指数分别为0．333、0．274。结论：螺旋CT检查对诊断子宫颈癌盆腔淋巴结转移的特异度较高，具有一定的参考价值；但灵敏度偏低，有待改进。     

Clinical value of multidetector row computed tomography in detecting lymph node metastasis of early gastric cancer.

AIMS: To evaluate the clinical value of multidetector row computed tomography (MDCT) as a pre-operative staging tool for lymph node metastasis in patients with early gastric cancer (EGC). METHODS: In 278 consecutive patients with EGC, lymph node metastasis was evaluated pre-operatively with MDCT at a slice thickness of 2.5mm (n=57), 5.0mm (n=188), or 7.5mm (n=33). RESULTS: Overall accuracy of nodal category from N0 to N3 was 86% for MDCT and 95% for operative assessment. Regarding accuracy in detecting at least one metastatic lymph node, area under curves (AUC) of receiver operating characteristics for 2.5, 5.0, and 7.5-mm slices and assessment during surgery were 0.87, 0.67 and 0.47, and 0.70, which were significantly different (P<0.0001). MDCT image with 2.5-mm could discriminate the presence of lymph node metastasis with diagnostic accuracy: sensitivity 80%; specificity 92%; positive predictive value (PPV) 50%; negative predictive value (NPV) 98%, whereas assessment during surgery was as follows: sensitivity 65%; specificity 98%; PPV 72%; and NPV 97%. CONCLUSIONS: These results suggest that pre-operative assessment with MDCT using thinner slices may detect at least one lymph node metastasis as accurately as assessment during surgery for patients with EGC.     

Radiation after pelvic lymphadenectomy: effect on morbidity

The role of a staging pelvic lymph node dissection has been questioned because of its associated morbidity, especially when followed by definitive radiation therapy. Forty-nine patients with clinically localized adenocarcinoma of the prostate underwent a staging pelvic lymphadenectomy. Clinically suspected lymph nodes were submitted for frozen section analysis. A unilateral dissection was performed on 7 patients (14%), none of whom developed intraoperative or postoperative complications. The remaining 42 patients underwent bilateral pelvic lymphadenectomy, after which 26 were treated with definitive radiation therapy using the four-field box technique, and 16 received other forms of therapy (delayed androgen deprivation or hormonal manipulation). The complication rate of 19% was identical for both groups of patients. Complications consisted of 3 seromas, 1 atelectasis, 1 prolonged ileus, 1 wound infection, and 2 transient penile or scrotal edemas. Radiation therapy, therefore, did not increase postoperative morbidity.     

非小细胞肺癌纵隔淋巴结分期:螺旋CT和病理检查对照

背景与目的:非小细胞肺癌纵隔淋巴结分期对肿瘤的规范化治疗方案的选择和预后判断具有极其重要的意义。本研究旨在通过比较螺旋CT和病理检查对非小细胞肺癌纵隔淋巴结分期的结果,评价螺旋CT检查对纵隔淋巴结分期的临床参考价值。方法:对89例病理确诊的非小细胞肺癌患者同时进行螺旋CT检查和纵隔镜检查,将CT对纵隔淋巴结分期结果与淋巴结最后病理分期做一一对照,对比分析螺旋CT检查诊断纵隔淋巴结转移的敏感性、特异性和准确率。结果:与纵隔淋巴结最后病理分期一一对照,螺旋CT检查诊断纵隔淋巴结转移的敏感性为58.9%,特异性为70.0%,阳性预测值60.5%,阴性预测值68.6%,总的准确率为65.2%。螺旋CT检查诊断4R、5、6、7组淋巴结转移的准确率和特异性偏低,诊断4R组和7组淋巴结转移的假阳性和假阴性较高。结论:螺旋CT检查对非小细胞肺癌纵隔淋巴结临床分期有一定的临床参考价值,但存在一定的假阳性和假阴性,应结合其他检查手段,比如纵隔镜,以进行更精确的分期。     

The role of para-aortic lymphadenectomy in endometrial cancer

Endometrial cancer (EC) is the most common malignancy of the female reproductive tract and the fourth most common cancer overall. Approximately 20 % of patients with EC harbor disease outside the uterus, and 10 % of patients initially diagnosed with cancer confined to the uterus are found to have lymph node metastases. Para-aortic lymph node involvement occurs in approximately 7–8 % of EC patients overall and in about 50 % of patients with positive pelvic nodes. Metastases to the para-aortic lymph nodes are associated with poor prognosis. Factors associated with para-aortic lymph node dissemination include advanced stage, high histological grade, deep myometrial invasion, cervical involvement, lymphovascular space involvement, and the presence of pelvic lymph node metastases. Approximately 77 % of patients with para-aortic nodal involvement are found to have metastases above the level of the inferior mesenteric artery. Systematic pelvic and para-aortic lymphadenectomy with dissection optimally carried out to the renal vessels is important in high-risk patients in order to identify nodes present at distant sites, particularly above the inferior mesenteric artery (IMA). While the definitive management of EC varies widely across the gynecological oncology community, there is a consensus that patients at risk for lymphatic metastases (high and intermediate risk) who are targeted with systematic lymphadenectomy may have an improved prognosis. Well-designed prospective studies evaluating the therapeutic role of systematic lymphadenectomy in EC are needed. Herein, we describe the role of para-aortic lymphadenectomy in the surgical staging of EC emphasizing its prerequisites, extent, and diagnostic and potential therapeutic advantages.     

子宫内膜癌与宫颈癌淋巴结转移分布的比较

目的:分析子宫内膜癌淋巴结转移模式并比较子宫内膜癌与宫颈癌淋巴结转移分布的不同.方法:回顾性分析接受系统的盆腔和腹主动脉旁淋巴结切除的104例子宫内膜癌以及253例宫颈癌患者淋巴结转移情况,比较二者的不同.结果:与宫颈癌相比,子宫内膜癌淋巴结转移率较高(22.1%vs 16.2%),并且子宫内膜癌的淋巴结转移与病理分级(G_1:12.1%;G_2:21.4%;G_3:34.5%)、肌层浸润深度(≤1/2:11.9%>1/2:29%)有关;子宫内膜癌单纯盆腔淋巴结转移率偏低(34.8% vs 68.3%),单纯腹腔淋巴结转移率偏高(4.3%vs 0),盆腹淋巴结共同受累的发生率偏高(60.9%vs 31.7%).宫颈癌中腹主动脉旁淋巴结转移的患者100%有盆腔淋巴结转移,而内膜癌93.3%的腹主动脉旁淋巴结阳性的患者有盆腔淋巴结转移.内膜癌与宫颈癌最易受累淋巴结均为闭孔淋巴结(内膜癌:73.9%、宫颈癌:70.7%),受累最少的均为腹股沟淋巴结(内膜癌:8.7%、宫颈癌:7.3%),与宫颈癌相比,子宫内膜癌腹主动脉旁淋巴结(65.2%vs 31.7%)、骶前淋巴结(21.7%vs 17.1%)的受累几率较高,而髂外淋巴结受累的几率偏低(17.4%vs 41.5%).结论:子宫内膜癌淋巴结转移方式不同于宫颈癌,虽然内膜癌主要向盆腔淋巴结转移,但是仍然存在直接向腹主动脉旁淋巴结转移的病例并且各病理分级的内膜癌均有淋巴结转移的可能.     

18F-FDG PET/CT显像在鼻咽癌分期与疗效监测中的临床应用价值

背景与目的:18F-脱氧葡萄糖(fluorine-18 fluorodeoxyglucose,18F-FDG)PET/CT显像可明显提高肺癌、食管癌等多种肿瘤的诊断、分期与疗效监测的准确性,有助于更准确地制定治疗方案.本研究探讨全身18F-FDG PET/CT显像在鼻咽癌首次分期、再分期及疗效监测中的临床应用价值.方法:回顾性分析澳大利亚Peter MacCallum肿瘤中心2002年2月至2005年12月43例鼻咽癌患者的18F-FDG PET/CT全身扫描报告,根据临床资料、病理结果及临床随访结果,计算18F-FDG PET/CT与传统影像学检查CT、MRI的准确性、特异性、灵敏度、阳性预测值与阴性预测值,并对结果进行比较和分析.结果:18F-FDGPET/CT诊断鼻咽癌总的准确率、敏感性、特异性、阳性预测值与阴性预测值分别为95.3%、100.0%、85.7%、93.8%、100.0%,传统影像学检查CT、MRI分别为65.5%、79.4%、64.7%、81.8%、57.9%. 18F-FDG PET/CT诊断结果使2例首次分期、7例再分期患者治疗方案得到改变,并影响1例首次分期和3例再分期患者治疗方案的制定;在疗效监测组中,指导医生修改治疗方案共11例(其中5例为原则性的修改).18F-FDG PET/CT检测到2例第二原发肿瘤,1例是甲状腺癌,1例是低度恶性胃癌.结论:18F-FDG PET/CT全身显像对鼻咽癌N、M分期与疗效监测的临床作用可能优于CT、MR检查.     

[18F]-FDG–PET in clinical stage I/II non-seminomatous germ cell tumours: results of the German multicentre trial

PurposeThe aim of this study was to determine the predictive values of 2-[fluorine-18]fluoro-2-deoxy-D-glucose–positron emission tomography (FDG–PET) in primary staging in patients with newly diagnosed non-seminomatous germ cell tumour (NSGCT) clinical stage I/II.Patients and methodsThe hypothesis was that FDG–PET would improve the negative predictive value (NPV) from 70% to 90%, thus requiring a total of 169 patients. All scans underwent visual analysis by a reference team of nuclear medicine physicians. Results were validated by histology following retroperitoneal lymph node dissection.ResultsOnly 72 of the planned 169 patients were included, due to poor accrual. The prevalence of nodal involvement was 26%. Correct nodal staging by FDG–PET was achieved in 83% compared with correct computed tomography (CT) staging in 71%. CT had a sensitivity and specificity of 41% and 95%, respectively. Positive predictive value (PPV) and NPV were 87% and 67%, respectively. FDG–PET had a sensitivity and specificity of 66% and 98%, respectively. PPV was 95%. The primary end point was not reached, with an NPV of 78%.ConclusionFDG–PET as a primary staging tool for NSGCT yielded only slightly better results than CT. Both methods had a high specificity while false-negative findings were more frequent with CT. FDG–PET is mostly useful as a diagnostic tool in case of questionable CT scan.