~(18)F-FDG PET/CT代谢参数对子宫内膜上皮内瘤变应用价值的临床研究
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摘要
目的评估术前氟化脱氧葡萄糖-正电子发射计算机断层显像/CT(~(18)F-FDG PET/CT)代谢参数对子宫内膜上皮内瘤变(EIN)诊断的有效性。方法选择2014年1月至2018年3月于中国医科大学附属盛京医院就诊的188例临床或内膜活检怀疑子宫内膜癌患者为研究对象,均于术前2周内行~(18)F-FDG PET/CT扫描,测定标准化摄取值峰值(SUV_(peak))、最大标准化摄取值(SUV_(max))、平均标准化摄取值(SUVmean)、肿瘤代谢体积(MTV)、病灶总糖酵解值(TLG),并与病理结果比较,评估其相关性。结果共纳入157例患者,其中EINⅠ～Ⅱ级55例、EINⅢ级48例、EINⅢ级合并局灶癌变54例。随着EIN分级的不断加重,SUV_(peak)、SUV_(max)、SUVmean、TLG整体的代谢值增高(P <0. 05)。SUV_(peak)、SUV_(max)、SUVmean与不同病理分级呈正相关(r_s=0. 701、0. 69、0. 667,均P <0. 01),TLG显示弱相关性(r_s=0. 423,P <0. 05),而MTV与不同病理分级无相关性(r_s=0. 114,P> 0. 05)。在区分EIN和局灶恶变组的诊断效能中,SUV_(peak)曲线下面积最大(AUC=0. 782),受试者工作特征曲线分析确定SUV_(peak)的Youden指数为0. 574,对应的最佳诊断界值为6. 25,灵敏度为77. 8%,特异度为79. 6%。结论 SUV_(peak)、SUV_(max)与EIN分级密切相关,相比MTV和TLG诊断价值更高,两者的应用有助于术前鉴别诊断。
Objective To assess the effectiveness of preoperative fludeoxyglucose positron emission tomography/computed tomography( ~(18)F-FDG PET/CT) metabolic parameter_s in the diagnosis of endometrial intraepithelial neoplasia( EIN).Methods From Jan. 2014 to Mar. 2018,188 patients with endometrial carcinoma suspected by clinical examination or endometrial biopsy were selected from Shengjing Hospital of China Medical Univer_sity. ~(18)F-FDG PET/CT scans were performed within 2 weeks before operation to determine the peak standard uptake value( SUV_(peak)),maximum standard uptake value( SUV_(max)),mean standard uptake value( SUVmean),metabolic tumor volume( MTV) and total lesion glycolysis( TLG). The results were compared with pathological results and the correlation was assessed. Results A total of157 patients were enrolled,including EINⅠ-Ⅱ 55 cases,EINⅢ 48 cases,and EINⅢ with focal carcinogenesis 54 cases. As the degree of EIN grading increased,the overall metabolic values of SUV_(peak),SUV_(max),SUVmean and TLG increased,and the differences were statistically significant( P < 0. 05). With the change of postoperative pathological characteristics,SUV_(peak),SUV_(max),SUVmean showed a significant positive correlation( r_s= 0. 701,0. 69,0. 667,all P < 0. 01),TLG showed weak correlation( r_s= 0. 423,P < 0. 05),and there was no statistical correlation with MTV( r_s= 0. 114,P > 0. 05).As for the diagnostic efficacies of EIN and focal malignant lesions,the area under curve of SUV_(peak)( AUC = 0. 782) was the largest,Youden index was 0. 574,the optimal diagnostic cut-off was 6. 25,with a sensitivity of 77. 8% and a specificity of 79. 6%. Conclusion SUV_(peak) and SUV_(max) are closely related to EIN classification,the diagnostic value of which is higher than that of MTV and TLG,and the application of which is conducive to the preoperative differential diagnosis.
Objective To assess the effectiveness of preoperative fludeoxyglucose positron emission tomography/computed tomography( ~(18)F-FDG PET/CT) metabolic parameter_s in the diagnosis of endometrial intraepithelial neoplasia( EIN).Methods From Jan. 2014 to Mar. 2018,188 patients with endometrial carcinoma suspected by clinical examination or endometrial biopsy were selected from Shengjing Hospital of China Medical Univer_sity. ~(18)F-FDG PET/CT scans were performed within 2 weeks before operation to determine the peak standard uptake value( SUV_(peak)),maximum standard uptake value( SUV_(max)),mean standard uptake value( SUVmean),metabolic tumor volume( MTV) and total lesion glycolysis( TLG). The results were compared with pathological results and the correlation was assessed. Results A total of157 patients were enrolled,including EINⅠ-Ⅱ 55 cases,EINⅢ 48 cases,and EINⅢ with focal carcinogenesis 54 cases. As the degree of EIN grading increased,the overall metabolic values of SUV_(peak),SUV_(max),SUVmean and TLG increased,and the differences were statistically significant( P < 0. 05). With the change of postoperative pathological characteristics,SUV_(peak),SUV_(max),SUVmean showed a significant positive correlation( r_s= 0. 701,0. 69,0. 667,all P < 0. 01),TLG showed weak correlation( r_s= 0. 423,P < 0. 05),and there was no statistical correlation with MTV( r_s= 0. 114,P > 0. 05).As for the diagnostic efficacies of EIN and focal malignant lesions,the area under curve of SUV_(peak)( AUC = 0. 782) was the largest,Youden index was 0. 574,the optimal diagnostic cut-off was 6. 25,with a sensitivity of 77. 8% and a specificity of 79. 6%. Conclusion SUV_(peak) and SUV_(max) are closely related to EIN classification,the diagnostic value of which is higher than that of MTV and TLG,and the application of which is conducive to the preoperative differential diagnosis.
引文
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[10] Akamatsu G, Ikari Y, Nishida H,et al. Influence of Statistical Fluctuation on Reproducibility and Accuracy of SUVmax and SUVpeak:A Phantom Study[J]. J Nucl Med Technol,2015,43(3):222-526.
[11] Xu W, Yu S,Xin J,et al. Relationship of~(18)F-FDG PET/CT metabolic, clinical and pathological characteristics of primary squamous cell carcinoma of the cervix[J]. J Investig Med,2016,64(8):1246-1251.
[12] Chen SW,Chen WT, Wu YC,et al. Which FDG/PET parameters of the primary tumors in colon or sigmoid cancer provide the best correlation with the pathological findings?[J]. Eur J Radiol,2013,82(9):405-410.
[13] Antonsen SL,Loft A,Fisker R,et al. SUVmax of~(18)FDG PET/CT as a predictor of high-risk endometrial cancer patients[J]. Gynecol Oncol,2013,129(2):298-303.
[14] Kitajima K,Kita M,Suzuki K,et al. Prognostic significance of SUVmax(maximum standardized uptake value)measured by~(18)FFDG PET/CT in endometrial cancer[J]. Eur J Nucl Med Mol Imaging, 2012,39(5):840-845.
[15] Sher A,Lacoeuille F, Fosse P,et al. For avid glucose tumors, the SUVpeak is the most reliable parameter for~(18)F FDG-PET/CT quantification, regardless of acquisition time[J]. EJNMMI Res,2016,6(1):21.
[16] Lee HJ, Ahn BC, Hong CM, et al. Preoperative risk stratification using~(18)F-FDG PET/CT in women with endometrial cancer[J].Nuklearmedizin,2011,50(5):204-313.
[17] Kitajima K,Suenaga Y, Ueno Y,et al. Preoperative risk stratification using metabolic parameters of 18F-FDG PET/CT in patients with endometrial cancer[J]. Eur J Nucl Med Mol Imaging,2015,42(8):12684275.
[18] Shim SH, Kim DY, Lee DY, et al. Metabolic tumour volume and total lesion glycolysis,measured using preoperative 18F-FDG PET/CT,predict the recurrence of endometrial cancer[J]. BJOG,2014,121(9):1097-1106.
[19] Husby JA,Reitan BC,Biermann M,et al. Metabolic Tumor Volume on~(18)F-FDG PET/CT Improves Preoperative Identification of HighRisk Endometrial Carcinoma Patients[J]. J Nucl Med, 2015,56(8):1191-4198.
[20] Chen YL, Wang KL,Chen MY,et al. Risk factor analysis of coexisting endometrial carcinoma in patients with endometrial hyperplasia:A retrospective observational study of Taiwanese Gyneco-logic Oncology Group[J]. J Gynecol Oncol,2013,24(1):14-20.
[2] Mutter GL,Zaino RJ,Baak JP,et al. Benign endometrial hyperplasia sequence and endometrial intraepithelial neoplasia[J]. Int J Gynecol Pathol,2007,26(2):103-1414.
[3]Leitao MM Jr,Han G,Lee LX,et al. Complex atypical hyperplasia of the uterus:Characteristics and prediction of underlying carcinoma risk[J]. Am J Obstet Gynecol,2010,203(4):1-6.
[4] Silverberg SG. Problems in the Differential Diagnosis of Endometrial Hyperplasia and Carcinoma[J]. Mod Pathol,2000,13(3):309-327.
[5] Li XC, Song WJ. Endometrial Intraepithelial Neoplasia(EIN)in endometrial biopsy specimens categorized by the 1994 World Health Organization classification for endometrial hyperplasia[J].Asian Pac J Cancer Prev,2013,14(10):5935-5939.
[6] Randall TC, Kurman RJ. Progestin treatment of atypical hyperplasia and well-differentiated carcinoma of the endometrium in women under age 40[J]. Obstet Gynecol, 1997,90(3):434-440.
[7] Laas E, Ballester M,Cortez A, et al. Supervised clustering of immunohistochemical markers to distinguish atypical and nonatypical endometrial hyperplasia[J]. Gynecol Endocrinol,2015,31(4):282-285.
[8] Kumar R,Halanaik D,Malhotra A. Clinical applications of positron emission tomography-computed tomography in oncology[J]. Indian J Cancer,2010,47(2):100419.
[9] Berg A,Gulati A, Ytre-Hauge S,et al. Preoperative imaging markers and PDZ-binding kinase tissue expression predict low-risk disease in endometrial hyperplasias and low grade cancers[J]. Oncotarget,2017,8(40):68530-68541.
[10] Akamatsu G, Ikari Y, Nishida H,et al. Influence of Statistical Fluctuation on Reproducibility and Accuracy of SUVmax and SUVpeak:A Phantom Study[J]. J Nucl Med Technol,2015,43(3):222-526.
[11] Xu W, Yu S,Xin J,et al. Relationship of~(18)F-FDG PET/CT metabolic, clinical and pathological characteristics of primary squamous cell carcinoma of the cervix[J]. J Investig Med,2016,64(8):1246-1251.
[12] Chen SW,Chen WT, Wu YC,et al. Which FDG/PET parameters of the primary tumors in colon or sigmoid cancer provide the best correlation with the pathological findings?[J]. Eur J Radiol,2013,82(9):405-410.
[13] Antonsen SL,Loft A,Fisker R,et al. SUVmax of~(18)FDG PET/CT as a predictor of high-risk endometrial cancer patients[J]. Gynecol Oncol,2013,129(2):298-303.
[14] Kitajima K,Kita M,Suzuki K,et al. Prognostic significance of SUVmax(maximum standardized uptake value)measured by~(18)FFDG PET/CT in endometrial cancer[J]. Eur J Nucl Med Mol Imaging, 2012,39(5):840-845.
[15] Sher A,Lacoeuille F, Fosse P,et al. For avid glucose tumors, the SUVpeak is the most reliable parameter for~(18)F FDG-PET/CT quantification, regardless of acquisition time[J]. EJNMMI Res,2016,6(1):21.
[16] Lee HJ, Ahn BC, Hong CM, et al. Preoperative risk stratification using~(18)F-FDG PET/CT in women with endometrial cancer[J].Nuklearmedizin,2011,50(5):204-313.
[17] Kitajima K,Suenaga Y, Ueno Y,et al. Preoperative risk stratification using metabolic parameters of 18F-FDG PET/CT in patients with endometrial cancer[J]. Eur J Nucl Med Mol Imaging,2015,42(8):12684275.
[18] Shim SH, Kim DY, Lee DY, et al. Metabolic tumour volume and total lesion glycolysis,measured using preoperative 18F-FDG PET/CT,predict the recurrence of endometrial cancer[J]. BJOG,2014,121(9):1097-1106.
[19] Husby JA,Reitan BC,Biermann M,et al. Metabolic Tumor Volume on~(18)F-FDG PET/CT Improves Preoperative Identification of HighRisk Endometrial Carcinoma Patients[J]. J Nucl Med, 2015,56(8):1191-4198.
[20] Chen YL, Wang KL,Chen MY,et al. Risk factor analysis of coexisting endometrial carcinoma in patients with endometrial hyperplasia:A retrospective observational study of Taiwanese Gyneco-logic Oncology Group[J]. J Gynecol Oncol,2013,24(1):14-20.