Comparative efficacy of positron emission tomography with FDG and computed tomographic scanning in preoperative staging of non-small cell lung cancer

OBJECTIVE: To determine the sensitivity, specificity, and accuracy of positron emission tomography with 2-fluorine-18-fluorodeoxyglucose (PET-FDG) in the preoperative staging (N and M staging) of patients with lung cancer. The authors wanted to compare the efficacy of PET scanning with currently used computed tomography (CT) scanning. MATERIALS AND METHODS: Results of whole-body PET-FDG imaging and CT scans were compared with histologic findings for the presence or absence of lymph node disease or metastatic sites. Sampling of mediastinal lymph nodes was performed using mediastinoscopy or thoracotomy. RESULTS: PET-FDG imaging was significantly more sensitive, specific, and accurate for detecting N disease than CT. PET changed N staging in 35% and M staging in 11% of patients. CT scans helped in accurate anatomic localization of 6/57 PET lymph node abnormalities. CONCLUSION: PET-FDG is a reliable method for preoperative staging of patients with lung cancer and would help to optimize management of these patients. Accurate lymph node staging of lung cancer may be ideally performed by simultaneous review of PET and CT scans.     

18F-FDG PET/CT in pancreatic adenocarcinoma: A role at initial imaging staging?

Pancreatic ductal adenocarcinoma represents 90% of all pancreatic tumors. The only hope for prolonged survival in patients with this condition still remains surgery with complete R0 resection. Initial imaging has a pivotal role to identify patients who are eligible to curative surgery and those who may benefit of neoadjuvant chemotherapy. This review provides an analysis of the recent literature on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in pancreatic adenocarcinoma. Performances of FDG PET in the detection of lymph node involvement and metastatic spread at initial staging and those in the assessment of response to treatment are described.     

Positron emission tomography for preoperative lymph node diagnosis in esophageal carcinoma]

BACKGROUND: Exact preoperative staging is a prerequisite for the indication and the choice of appropriate operative technique for patients with esophageal carcinoma. The objective of this prospective study was to assess whether positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) increases the accuracy of preoperative lymph node staging with standard computed tomography (CT) and thus leads to a different surgical approach. PATIENTS AND METHODS: Fifty-eight patients with carcinoma of the esophagus (46 men and 12 women) with a median age of 61 years underwent FDG-PET imaging of the neck, chest, and abdomen as well as CT of the chest and abdomen. Sensitivity, specificity, and accuracy were calculated for both imaging techniques to evaluate the detection of histologically verified lymph node metastases. RESULTS: The FDG-PET showed higher specificity, whereas CT proved to be more accurate for detecting lymph node metastases not only of the abdomen (73% vs 59%) but also of the thorax (73% vs 63%). Resections were transhiatal in 23 patients and transthoracal in 16. As a supplement to conventional CT diagnostic procedure, FDG-PET was not decisive for the surgical approach. CONCLUSIONS: Altogether, pretherapeutical PET imaging did not increase the accuracy of lymph node staging for our patients with esophageal carcinoma, which had already been defined through CT. Therefore, no new consequences resulted for the surgical procedure. Due to the high costs involved with PET investigation, lymph node staging with it is momentarily indicated mainly for clinical studies and when CT does not offer unequivocal results. Increased sensitivity of the already advantageous whole-body FDG-PET imaging by means of tumor-affinitive radiopharmaceuticals and optimized apparatus resolution could lead to new indications for this staging procedure.     

18F-PSMA PET/CT与mpMRI对前列腺癌盆腔淋巴结转移诊断价值的比较

目的比较18F-前列腺特异性膜抗原(PSMA)-1007 PET/CT与多参数磁共振(mpMRI)对前列腺癌盆腔淋巴结转移的诊断效能。方法回顾性分析2018年11月至2021年4月于四川省肿瘤医院同期行18F-PSMA-1007 PET/CT和mpMRI检查的30例前列腺癌患者的临床病理资料。年龄(68.4±6.4)岁, 术前血清总前列腺特异性抗原45.70(16.07, 100.00)ng/ml。30例中14例PET/CT淋巴结阳性, 7例mpMRI淋巴结阳性。术前临床T分期:T1期1例, T2期20例, T3期6例, T4期3例;危险度分层高危29例, 中危1例。30例均行腹腔镜根治性前列腺切除术+盆腔扩大淋巴结清扫术。根据术后淋巴结病理检查结果, 分析两种影像学检查诊断前列腺癌盆腔淋巴结转移的敏感性、特异性、阳性预测值和阴性预测值, 同时采用Kappa检验分析两种影像学检查与术后淋巴结病理结果的一致性。结果本组30例术后病理均为前列腺癌, 其中10例盆腔淋巴结阳性。以术后病理作为诊断金标准, 按照盆腔淋巴结转移例数计算诊断效能, 18F-PSMA-1007 PET/CT的敏感性、...     

Clinical usefulness of 18-fluorodeoxyglucose positron emission tomography in the management of patients with nonpancreatic periampullary neoplasms

BACKGROUND: 18-Fluorodeoxyglucose positron emission tomography (18-FDG PET) has been investigated for the diagnosis and staging of gastrointestinal malignancies including pancreatic adenocarcinoma. The aim of this study was to examine the clinical usefulness of 18-FDG PET in the diagnosis and follow-up evaluation of patients with periampullary neoplasms. METHODS: Twenty-five patients underwent whole-body 18-FDG PET and abdominal computed tomography (CT). Pathologic confirmation was obtained in all patients by surgical resection or biopsy examination. The 18-FDG PET was analyzed visually and semiquantitatively using the standard uptake value (SUV). Positivity was assumed when a focal uptake occurred with an SUV of 2.5 or greater. RESULTS: Between January 1998 and December 2003, 14 ampullary, 7 bile duct, and 4 duodenal tumors were included in the study. PET showed increased focal uptake in 22 patients (88%): 11 of 14 (79%) ampullary tumors, and 100% of bile duct and duodenal tumors. PET showed a focal uptake in 11 of 12 patients without detectable mass at CT scan, and lymph node metastases in 6 patients. An SUV value of 2.7 discriminated adenomas or noninvasive cancers (n = 6) from invasive malignancies (n = 14). Follow-up evaluation including CT scan and PET was performed in 12 patients: PET showed recurrent disease not seen by CT in 4 patients, confirmed CT findings in 6 patients, and showed an unsuspected primary lung cancer in 1 patient and colon cancer in another patient. CONCLUSIONS: 18-FDG PET is very sensitive for detecting periampullary neoplasms. It may be useful to differentiate benign or borderline lesions from invasive tumors when no mass has been identified by traditional imaging. Finally, it is very useful in the follow-up evaluation of resected patients to identify recurrent disease or other malignancies.     

Role of PET/CT in muscle-invasive bladder cancer

The purpose of this study covered the diagnostic accuracy and usefulness of positron emission tomography/computed tomography (PET/CT) imaging in muscle invasive bladder cancer patients through previously published literature. Through 30 September, 2019, the PubMed database was searched for eligible articles that evaluated PET/CT imaging in bladder cancer patients. In general, FDG PET/CT, the most commonly used PET/CT imaging, does not show good performance for the detection of primary lesions; however, according to the literature it could accurately assess pelvic lymph node (LN) status better than other imaging technologies and it was especially helpful in determining extra-pelvic recurrences. More recently, non-FDG PET/CT imaging, such as C-11 acetate and C-11 choline, has been introduced. Although further research is required, preliminary results show the potential of these techniques to overcome the drawbacks of FDG. This concise study will overview the role of PET/CT when treating muscle-invasive bladder cancer (MIBC).     

Standardized Uptake Values from PET/MRI in Metastatic Breast Cancer: An Organ‐based Comparison With PET/CT

Quantitative standardized uptake values (SUVs) from fluorine‐18 (18F) fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) are commonly used to evaluate the extent of disease and response to treatment in breast cancer patients. Recently, PET/magnetic resonance imaging (MRI) has been shown to qualitatively detect metastases from various primary cancers with similar sensitivity to PET/CT. However, quantitative validation of PET/MRI requires assessing the reliability of SUVs from MR attenuation correction (MRAC) relative to CT attenuation correction (CTAC). The purpose of this retrospective study was to assess the utility of PET/MRI‐derived SUVs in breast cancer patients by testing the hypothesis that SUVs derived from MRAC correlate well with those from CTAC. Between August 2012 and May 2013, 35 breast cancer patients (age 37–78 years, 1 man) underwent clinical 18F‐FDG PET/CT followed by PET/MRI. One hundred seventy metastases were seen in 21 of 35 patients; metastases to bone in 16 patients, to liver in seven patients, and to nonaxillary lymph nodes in eight patients were sufficient for statistical analysis on an organ‐specific per patient basis. SUVs in the most FDG‐avid metastasis per organ per patient from PET/CT and PET/MRI were measured and compared using Pearson's correlations. Correlations between CTAC‐ and MRAC‐derived SUVmax and SUVmean in 31 metastases to bone, liver, and nonaxillary lymph nodes were strong overall (ρ = 0.80, 0.81). SUVmax and SUVmean correlations were also strong on an organ‐specific basis in 16 bone metastases (ρ = 0.76, 0.74), seven liver metastases (ρ = 0.85, 0.83), and eight nonaxillary lymph node metastases (ρ = 0.95, 0.91). These strong organ‐specific correlations between SUVs from PET/CT and PET/MRI in breast cancer metastases support the use of SUVs from PET/MRI for quantitation of 18F‐FDG activity.     

Molecular positron emission tomography and PET/CT imaging in urological malignancies

OBJECTIVES: Positron emission tomography (PET) provides unique insights into molecular pathways of diseases. PET using [F-18]-fluorodeoxyglucose (FDG) has gained increasing acceptance for the diagnosis, staging, and treatment monitoring of various tumour types. The aim of this review is to provide an update on the current status of molecular PET and PET/CT imaging in urological malignancies. METHODS: The current literature on PET and PET/CT imaging was reviewed and summarized for prostate cancer, bladder cancer, renal cell carcinoma, and germ cell tumours. RESULTS: Depending on the radiotracer used, PET offers diagnostic information based on glucose, choline or amino acid metabolism and has also been applied to imaging tumour cell proliferation and tissue hypoxia in urological malignancies. The diagnostic performance of FDG-PET is hampered by the renal excretion of FDG and by the low metabolic activity often seen in tumours such as prostate cancer. However, new PET tracers including radiolabelled choline and acetate may offer an alternative approach. There is consistent evidence that FDG-PET provides important diagnostic information in detecting metastatic and recurrent germ cell tumours and it might offer additional information in the staging and restaging of bladder and renal cancer. CONCLUSIONS: Although PET imaging has been shown to be a clinically useful tool, its application in urological malignancies still needs to be fully determined by larger prospective trials. The introduction of novel PET radiopharmaceuticals along with the new technology of PET/CT will likely change the future role of molecular imaging in urological malignancies.     

Bedeutung der radiologischen Bildgebung für die Lymphknotenchirurgie urologischer Malignome

This review illustrates the relevance of computed tomography (CT) and magnetic resonance imaging (MRI) for detecting or excluding lymph node metastases in urological malignancies. Although radiological assessment of lymph node metastases is well established in renal cell and testicular cancer, it is unreliable in prostate, bladder, and penile cancer. MR lymphography has shown promising results in these tumors, but because marketing authorization for the iron oxide contrast agent is lacking, it is not clinically applicable. Percutaneous CT-guided biopsy in the retroperitoneum and pelvis is introduced as an alternative in the histological exploration of suspicious lymph nodes.     

Die Positronenemissionstomographie zur präoperativen Lymphknotendiagnostik bei Ösophaguskarzinom

Background

Exact preoperative staging is a prerequisite for the indication and the choice of appropriate operative technique for patients with esophageal carcinoma. The objective of this prospective study was to assess whether positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) increases the accuracy of preoperative lymph node staging with standard computed tomography (CT) and thus leads to a different surgical approach.

Patients and methods

Fifty-eight patients with carcinoma of the esophagus (46 men and 12 women) with a median age of 61 years underwent FDG-PET imaging of the neck, chest, and abdomen as well as CT of the chest and abdomen. Sensitivity, specificity, and accuracy were calculated for both imaging techniques to evaluate the detection of histologically verified lymph node metastases.

Results

The FDG-PET showed higher specificity, whereas CT proved to be more accurate for detecting lymph node metastases not only of the abdomen (73% vs 59%) but also of the thorax (73% vs 63%). Resections were transhiatal in 23 patients and transthoracal in 16. As a supplement to conventional CT diagnostic procedure, FDG-PET was not decisive for the surgical approach.

Conclusions

Altogether, pretherapeutical PET imaging did not increase the accuracy of lymph node staging for our patients with esophageal carcinoma, which had already been defined through CT. Therefore, no new consequences resulted for the surgical procedure. Due to the high costs involved with PET investigation, lymph node staging with it is momentarily indicated mainly for clinical studies and when CT does not offer unequivocal results. Increased sensitivity of the already advantageous whole-body FDG-PET imaging by means of tumor-affinitive radiopharmaceuticals and optimized apparatus resolution could lead to new indications for this staging procedure.     

Application of whole-body positron emission tomography in the imaging of esophageal cancer: Report of a case

We describe herein a case of esophageal cancer in which both primary and metastatic lymph node foci were successfully imaged with whole-body positron emission tomography (PET) scanning. A 75-year-old woman with biopsy-proven squamous cell carcinoma of the esophagus underwent whole-body PET scanning for staging evaluation. The patient was injected with 373.7 MBq [¹⁸F]-2-fluoro-2-d-deoxyglucose (FDG), and 60 min later, scanning was performed from the neck to the pelvis. The whole-body images showed intense FDG uptake in the primary lesion and multiple focal areas of increased FDG uptake in the mediastinum and abdomen, which corresponded to the lymph node foci confirmed by computed tomography (CT) scan. To our knowledge, this is the first report of whole-body PET scanning being applied in the imaging of esophageal cancer.     

Funktionelle Bildgebung beim Harnblasenkarzinom

Computed tomography (CT) represents the current standard imaging modality in muscle invasive bladder cancer; however, local tumor and lymph node staging is often impaired. Magnetic resonance imaging (MRI) with diffusion-weighted sequences, determination of apparent diffusion coefficient (ADC) values or utilization of supraparamagnetic iron nanoparticles potentially exhibits advantages in the assessment of local tumor and lymph node involvement and therefore might play a role in the staging of bladder tumor in the future. Likewise, positron emission tomography (PET) with the currently used tracers ¹⁸F fluorodeoxyglucose (¹⁸F-FDG), ¹¹C-choline and ¹¹C-acetate is being investigated in bladder cancer patients, mostly in combination with diagnostic CT. Although promising results could be obtained for PET/CT investigations to some extent, the true value cannot be determined at present.     

Role of positron emission tomography in urological oncology

??Positron emission tomography (PET) is a diagnostic tool using radiotracers to show changes in metabolic activities in tissues. We analysed the role of PET and PET/computed tomography (CT) in the diagnosis, staging, and follow-up of urological tumours. ??A critical, non-structured review of the literature of the role of PET and PET/CT in urological oncology was conducted. ??PET and PET/CT can play a role in the management of urological malignancies. For prostate cancer, the advances in radiotracers seems promising, with novel radiotracers yielding better diagnostic and staging results than 18F-fluorodeoxyglucose (18F-FDG). In kidney cancer, PET and PET/CT allow a proper diagnosis before the pathological examination of the surgical specimen. For testis cancer, PET and PET/CT have been shown to be useful in the management of seminoma tumours. In bladder cancer, these scans allow a better initial diagnosis for invasive cancer, while detecting occult metastases. ??PET and its combined modality PET/CT have shown their potential in the diagnosis of urological malignancies. However, further studies are needed to establish the role of PET in the management of these diseases. Future applications of PET may involve fusion techniques such as magnetic resonance imaging with PET.     

Sinnvolle bildgebende Diagnostik des lokal fortgeschrittenen Prostatakarzinoms

Prostate cancer is one of the principal medical problems facing the male population in developed countries with an increasing need for sophisticated imaging techniques and risk-adapted treatment options. This article presents an overview of the current imaging procedures in the diagnosis of locally advanced prostate cancer. Apart from conventional gray-scale transrectal ultrasound (TRUS) as the most frequently used primary imaging modality we describe computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). CT and MRI not only allow assessment of prostate anatomy but also a specific evaluation of the pelvic region. Color-coded and contrast-enhanced ultrasound, real-time elastography, dynamic contrast enhancement in MR imaging, diffusion imaging, and MR spectroscopy may lead to a clinically relevant improvement in the diagnosis of prostate cancer. While bone scintigraphy with (99m)Tc-bisphosphonates is still the method of choice in the evaluation of bone metastasis, whole-body MRI and PET using (18)F-NaF, (18)F-FDG, (11)C-choline, (11)C-acetate, and (18)F-choline as tracers achieve higher sensitivities.     

18F-fluorocholine PET/CT compared with extended pelvic lymph node dissection in high-risk prostate cancer

Purpose

To compare ¹⁸F-fluorocholine positron-emission tomography/computed tomography (PET/CT) with extended pelvic lymph node dissection (ePLND) for the detection of lymph node metastases in a large cohort of patients with high-risk prostate cancer.

Materials and methods

Patients with prostate-specific antigen levels between 20 and 99 ng/mL and/or Gleason score 8–10 cancers, planned for treatment with curative intent following a negative or inconclusive standard bone scan, were investigated with ¹⁸F-fluorocholine PET/CT followed by an ePLND. None of the patients received hormonal therapy prior to these staging procedures. Results for PET/CT were compared on a per-patient basis with histopathology from ePLND. Sensitivity, specificity, positive and negative predictive values were calculated.

Results

PET/CT detected a total of 76 suspected lymph node metastases and four suspected bone metastases in 33 (29 %) of the 112 included patients. Of these, 35 suspected lymph node metastases, only within the anatomical template area of an ePLND, were found in 21 of the patients. Histopathology of the ePLND specimens detected 117 lymph node metastases in 48 (43 %) of the 112 patients. Per-patient sensitivity, specificity, positive and negative predictive values for ¹⁸F-fluorocholine PET/CT for lymph node metastases within the ePLND template were 0.33, 0.92, 0.76 and 0.65, respectively. Only 11 patients had lymph nodes larger than 10 mm that would have been reported by CT alone.

Conclusions

¹⁸F-fluorocholine PET/CT detects lymph node metastases in a significant proportion of patients with high-risk prostate cancer with a high specificity, but low sensitivity.     

Accuracy of 18-Fluoro-2-deoxy-d-glucose Positron Emission Tomography in the Pretherapeutic Detection of Occult Para-aortic Node Involvement in Patients with a Locally Advanced Cervical Carcinoma

Purpose

Patients with locally advanced cervical cancer (LACC) are usually treated with concurrent chemoradiotherapy. Extended-field chemoradiotherapy is indicated in case of para-aortic node involvement at initial assessment. 18-Fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (18-FDG PET/CT) is currently considered to be the most accurate method of detection of node or distant metastases. The goal of this study was to evaluate the accuracy of PET at detecting para-aortic lymph node metastases in LACC patients with a negative morphological imaging.

Methods

Patients from five French institutions with LACC and both negative morphologic (magnetic resonance imaging, CT scan) and functional (PET or PET/CT) findings at the para-aortic level and distantly were submitted to a systematic infrarenal para-aortic node dissection either by laparoscopy or laparotomy. On the basis of pathological results, sensitivity, specificity, and positive and negative predictive values of PET/CT were assessed for para-aortic lymph node involvement.

Results

A total of 125 LACC patients (stage IB2–IVA disease with two local recurrences) fulfilled the inclusion criteria. All had an ilio-infrarenal para-aortic lymphadenectomy, either by laparoscopy (n = 117) or laparotomy (n = 8). Twenty-one patients (16.8%) had pathologically proven para-aortic metastases. Among them, 14 (66.7%) had negative PET/CT. Overall morbidity of surgery was 7.2%. All but one of the complications were mild and did not delay chemoradiotherapy. Sensitivity, specificity, and positive and negative predictive value of the PET/CT were 33.3, 94.2, 53.8, and 87.5%, respectively, for the detection of microscopic lymph node metastases.

Conclusions

Laparoscopic staging surgery seems warranted in LACC patients with negative PET scan who are candidates for definitive concurrent chemoradiotherapy or exenteration.

     

Advances in medical imaging for the diagnosis and management of common genitourinary cancers

Medical imaging of the 3 most common genitourinary (GU) cancers—prostate adenocarcinoma, renal cell carcinoma, and urothelial carcinoma of the bladder—has evolved significantly during the last decades. The most commonly used imaging modalities for the diagnosis, staging, and follow-up of GU cancers are computed tomography, magnetic resonance imaging (MRI), and positron emission tomography (PET). Multiplanar multidetector computed tomography and multiparametric MRI with diffusion-weighted imaging are the main imaging modalities for renal cell carcinoma and urothelial carcinoma, and although multiparametric MRI is rapidly becoming the main imaging tool in the evaluation of prostate adenocarcinoma, biopsy is still required for diagnosis. Functional and molecular imaging using 18-fluorodeoxyglucose-PET and sodium fluoride-PET are essential for the diagnosis, and especially follow-up, of metastatic GU tumors. This review provides an overview of the latest advances in the imaging of these 3 major GU cancers.     

Utility of ¹⁸F-FDG PET/CT in identifying penile squamous cell carcinoma metastatic lymph nodes

ObjectivesDue to the significant potential morbidity of inguinal and pelvic lymphadenectomy, the search for an imaging modality that can accurately identify penile squamous cell carcinoma (SCCA) lymphatic metastases continues. Initial ¹⁸F-FDG PET/CT studies have reported 80% sensitivity and 100% specificity in the detection of inguinal and obturator lymph node metastasis. We review a single institutional experience of ¹⁸F-FDG PET/CT imaging of SCCA of the penis to assess for accuracy and potential impact on clinical management.MethodsThree patients diagnosed with penile SCCA at a single institution underwent staging ¹⁸F-FDG PET/CT and went on to subsequent inguinal lymph node dissection. The ¹⁸F-FDG PET machine was a Philips Gemini Time-of-Flight PET with LYSO crystals with 4.7 mm spatial resolution. The CT was a 16-slice helical CT with 5 mm slice widths. ¹⁸F-FDG PET/CT findings were compared with the histologic findings of these procedures. Decision to proceed with lymphadenectomy was based on clinical judgment of a single urologist and all fused ¹⁸F-FDG PET/CT imaging was assessed by a single experienced radiologist.ResultsNo patient received chemotherapy or radiation before the ¹⁸F-FDG PET/CT or surgery. The first patient was obese (BMI > 30), clinically node negative, and the ¹⁸F-FDG PET/CT showed inflammation. Histologic examination showed a positive 2 cm right inguinal metastatic node. The second patient's ¹⁸F-FDG PET/CT showed a suspicious 1 cm left inguinal node. Histologically, the suspicious lymph node was positive for SCCA as was a second positive 2 cm lymph node not identified on preoperative ¹⁸F-FDG PET/CT. Clinical exam of this patient was negative. The third patient was ¹⁸F-FDG PET/CT and clinically negative but subsequently developed a palpable lymph node approximately 1 month later, which was suspicious on repeat ¹⁸F-FDG PET/CT and positive for SCCA on histological examination.Conclusions¹⁸F-FDG PET/CT has shown initial promise in the staging of penile SCCA. However, our review shows that false negative studies occur at alarmingly high rates, and ¹⁸F-FDG PET/CT is poor in detection of micro-metastasis. Thus, close follow-up in these patients is imperative.     

Evaluation of fluorodeoxyglucose positron‐emission tomography with computed tomography for staging of urothelial carcinoma

Study Type – Diagnostic (case series)
Level of Evidence 4

OBJECTIVE

To investigate the role of ¹⁸F‐fluorodeoxyglusose positron‐emission tomography (FDG‐PET), combined with computed tomography (CT) and forced diuresis, in the staging and follow‐up of urothelial carcinoma (UC).

PATIENTS AND METHODS

We recruited 44 patients with muscle‐invasive urothelial bladder cancer (UBC) before radical cystectomy (RC), 19 under follow‐up after RC and seven after systemic chemotherapy. For those who had RC, histopathology was used as the reference standard to compare the sensitivity and specificity of FDG‐PET/CT and standard CT in detecting UBC and pelvic lymph node metastasis. Furthermore, 36 patients with ≥6 months of follow‐up imaging were considered to describe the progression of UC and extrapelvic positive FDG‐PET/CT images.

RESULTS

For the detection of primary UBC, FDG‐PET/CT was slightly more sensitive than CT (85% vs 77%) but less specific (25% vs 50%). For the detection of pelvic node metastasis FDG‐PET/CT was more sensitive than CT (57% vs 33%) with a specificity of 100% for both imaging techniques. In 20 patients, extrapelvic FDG‐PET/CT images showed suspected disease at the first evaluation. UC progressed in nine of the 10 patients who had synchronous multiple PET‐positive retroperitoneal or mediastinal lymph nodes, and in only two of the nine with unique hyperactive lesions in the lung. FDG‐PET/CT also detected a pT1G3 UC of the renal pelvis and all bone metastases detected by bone scintigraphy.

CONCLUSIONS

FDG‐PET/CT could replace standard CT and bone scintigraphy in the presurgical staging and monitoring of patients with UC after surgery or chemotherapy.     

PET/CT诊断乳腺癌及腋窝淋巴结状态的作用评价

目的：评价PET／CT诊断乳腺癌和腋窝淋巴结转移的临床价值。方法：对33例疑似乳腺癌病人进行PET／CT检查，定性分析肿瘤病灶、淋巴结摄取氟脱氧葡萄糖（FDG）的程度，半定量测量标准摄取值（SUV），根据乳腺和淋巴结的FDG摄取强度诊断乳腺癌和淋巴结转移，检验SUV与乳腺癌分化程度、有丝分裂计数的关联性。结果：PET／CT诊断乳腺癌和腋窝淋巴结转移的敏感度、特异度和精确度分别为92．6％、100％、93．9％和82．3％、90％、85．2％；SUV与乳腺癌分化程度、有丝分裂计数显著相关（P〈0．05）；诊断乳腺癌的Kappa指数=0．835，μ=8．48，（P〈0．01）。结论：PET／CT诊断乳腺癌和腋窝淋巴结转移的敏感度、特异度较高，作为一种非侵袭性检查方法，可提供乳腺癌在活体内的多方面生物学信息，为选择合理的手术方式及新辅助化疗提供参考，弥补传统检查方法的不足。