PET/CT在子宫内膜癌中的应用
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摘要
子宫内膜癌是妇科常见的恶性肿瘤之一,总体预后较好,准确的术前分期及评估子宫外受累风险决定了手术方式和范围。正电子发射型计算机体层摄影术/计算机体层扫描不仅在诊断子宫内膜癌盆腔、腹主动脉旁淋巴结转移、远处转移及评价预后、复发诊断等方面具有其独特的价值,而且原发灶的最大标准摄取值、肿瘤代谢总体积和病灶总糖酵解量等参数更有望作为术前评估子宫内膜癌预后的重要无创性指标。
Endometrium carcinoma is one of the most common malignant tumors in gynecology,and the overall prognosis is good. Accurate preoperative staging and assessment of the risk of ectopic involvement determine the surgical approach and scope. PET / CT has a unique value in diagnosis of endometrium carcinoma,lymph node metastases of pelvic and para-aortic,distant metastasis,evaluating prognosis and recurrence diagnosis,etc. Furthermore,parameters such as maximum standard uptake value of primary lesion,total volume of cancer metabolism and total lesion glycolysis,etc,are expected to be the important non-invasive index to evaluate the prognosis of endometrial carcinoma.
Endometrium carcinoma is one of the most common malignant tumors in gynecology,and the overall prognosis is good. Accurate preoperative staging and assessment of the risk of ectopic involvement determine the surgical approach and scope. PET / CT has a unique value in diagnosis of endometrium carcinoma,lymph node metastases of pelvic and para-aortic,distant metastasis,evaluating prognosis and recurrence diagnosis,etc. Furthermore,parameters such as maximum standard uptake value of primary lesion,total volume of cancer metabolism and total lesion glycolysis,etc,are expected to be the important non-invasive index to evaluate the prognosis of endometrial carcinoma.
引文
[1]杨晓辉,李小毛.发病年龄对子宫内膜癌预后的影响.广东医学,2015,36(7):1033-1036.
[2]Siegel RL,Miller KD,Jemal A.Cancer statistics,2016.CACancer J Clin,2016,66(1):7-30.
[3]Chen W,Zheng R,Baade PD,Zhang S,Zeng H,Bray F,Jemal A,Yu XQ,He J.Cancer statistics in China,2015.CACancer J Clin,2016,66(2):115-132.
[4]Ascher SM,Reinhold C.Imaging of cancer of the endometrium.Radiol Clin North Am,2002,40(3):563-576.
[5]Lewin SN,Herzog TJ,Barrena Medel NI,Deutsch I,Burke WM,Sun X,Wright JD.Comparative performance of the 2009international Federation of gynecology and obstetrics'stagingsystem for uterine corpus cancer.Obstet Gynecol,2010,116(5):1141-1149.
[6]Tirumani SH,Shanbhogue AK,Prasad SR.Current concepts in the diagnosis and management of endometrial and cervical carcinomas.Radiol Clin North Am,2013,51(6):1087-1110.
[7]Lerman H,Metser U,Grisaru D,Fishman A,Lievshitz G,E-ven-Sapir E.Normal and abnormal18F-FDG endometrial and ovarian uptake in pre-and postmenopausal patients:assessment by PET/CT.J Nucl Med,2004,45(2):266-271.
[8]Liu Y.Benign ovarian and endometrial uptake on FDG PET-CT:patterns and pitfalls.Ann Nucl Med,2009,23(2):107-112.
[9]Nishizawa S,Inubushi M,Okada H.Physiological 18F-FDG uptake in the ovaries and uterus of healthy female volunteers.Eur JNucl Med Mol Imaging,2005,32(5):549-556.
[10]Kim SK,Kang KW,Roh JW,Sim JS,Lee ES,Park SY.Incidental ovarian18F-FDG accumulation on PET:correlation with the menstrual cycle.Eur J Nucl Med Mol Imaging,2005,32(7):757-763.
[11]刘穗玲,李小毛.分段诊断性刮宫在子宫内膜癌中应用的再认识.新医学,2011,42(11):701-704.
[12]Amit A,Person O,Keidar Z.FDG PET/CT in monitoring response to treatment in gynecological malignancies.Curr Opin Obstet Gynecol,2013,25(1):17-22.
[13]Kakhki VR,Shahriari S,Treglia G,Hasanzadeh M,Zakavi SR,Yousefi Z,Kadkhodayan S,Sadeghi R.Diagnostic performance of fluorine 18 fluorodeoxyglucose positron emission tomography imaging fordetection of primary lesion and staging of endometrial cancer patients:systematic review and meta-analysis of the literature.Int J Gynecol Cancer,2013,23(9):1536-1543.
[14]Gallego JC,Porta A,Pardo MC,Fernández C.Evaluation of myometrial invasion in endometrial cancer:comparison of diffusion-weighted magneticresonance and intraoperative frozen sections.Abdom Imaging,2014,39(5):1021-1026.
[15]Antonsen SL,Jensen LN,Loft A,Berthelsen AK,Costa J,Tabor A,Qvist I,Hansen MR,Fisker R,Andersen ES,Sperling L,Nielsen AL,Asmussen J,Hgdall E,Fag-Olsen CL,Christensen IJ,Nedergaard L,Jochumsen K,Hgdall C.MRI,PET/CT and ultrasound in the preoperative staging of endometrial cancer-a multicenter prospectivecomparative study.Gynecol Oncol,2013,128(2):300-308.
[16]Park JY,Kim EN,Kim DY,Suh DS,Kim JH,Kim YM,Kim YT,Nam JH.Comparison of the validity of magnetic resonance imaging and positron emission tomography/computedtomography in the preoperative evaluation of patients with uterine corpus cancer.Gynecol Oncol,2008,108(3):486-492.
[17]Kitajima K,Yamasaki E,Kaji Y,Murakami K,Sugimura K.Comparison of DWI and PET/CT in evaluation of lymph node metastasis in uterine cancer.World J Radiol,2012,4(5):207-214.
[18]Crivellaro C,Signorelli M,Guerra L,De Ponti E,Pirovano C,Fruscio R,Elisei F,Montanelli L,Buda A,Messa C.Tailoring systematic lymphadenectomy in high-risk clinical early stage endometrial cancer:the role of18F-FDG PET/CT.Gynecol Oncol,2013,130(2):306-311.
[19]Fischer BM,Olsen MW,Ley CD,Klausen TL,Mortensen J,Hjgaard L,Kristjansen PE.How few cancer cells can be detected by positron emission tomography?A frequent question addressedby an in vitro study.Eur J Nucl Med Mol Imaging,2006,33(6):697-702.
[20]Grisaru D,Almog B,Levine C,Metser U,Fishman A,Lerman H,Lessing JB,Even-Sapir E.The diagnostic accuracy of 18F-fluorodeoxyglucose PET/CT in patients with gynecological malignancies.Gynecol Oncol,2004,94(3):680-684.
[21]Ho L,Sheth S,Seto J.Intramuscular metastasis of endometrial carcinoma on FDG PET/CT.Clin Nucl Med,2010,35(8):607-609.
[22]Ortac F,Taskin S.Inguinal recurrence of early stage endometrial cancer after 7 months of surgical staging:the role of PET-CT in diagnosis and management.Int J Clin Oncol,2012,17(3):283-285.
[23]Nishiyama Y,Yamamoto Y,Kanenishi K,Ohno M,Hata T,Kushida Y,Haba R,Ohkawa M.Monitoring the neoadjuvant therapy response in gynecological cancer patients using FDGPET.Eur J Nucl Med Mol Imaging,2008,35(2):287-295.
[24]Sharma P,Kumar R,Singh H,Jeph S,Sharma DN,Bal C,Malhotra A.Carcinoma endometrium:role of 18-FDG PET/CT for detection of suspected recurrence.Clin Nucl Med,2012,37(7):649-655.
[25]Kadkhodayan S,Shahriari S,Treglia G,Yousefi Z,Sadeghi R.Accuracy of 18-F-FDG PET imaging in the follow up of endometrial cancer patients:systematic review andmeta-analysis of the literature.Gynecol Oncol,2013,128(2):397-404.
[26]Ozcan Kara P,Kara T,Kaya B,Kara Gedik G,Sari O.The value of FDG-PET/CT in the post-treatment evaluation of endometrial carcinoma:a comparison of PET/CT findings with conventional imaging and CA125 as a tumour marker.Rev Esp Med Nucl Imagen Mol,2012,31(5):257-260.
[27]Kitajima K,Suzuki K,Nakamoto Y,Onishi Y,Sakamoto S,Senda M,Kita M,Sugimura K.Low-dose non-enhanced CT versus full-dose contrast-enhanced CT in integrated PET/CT studies for thediagnosis of uterine cancer recurrence.Eur J Nucl Med Mol Imaging,2010,37(8):1490-1498.
[28]Antonsen SL,Loft A,Fisker R,Nielsen AL,Andersen ES,Hgdall E,Tabor A,Jochumsen K,Fag-Olsen CL,Asmussen J,Berthelsen AK,Christensen IJ,Hgdall C.SUVmaxof18FDGPET/CT as a predictor of high-risk endometrial cancer patients.Gynecol Oncol,201,129(2):298-303.
[29]Kitajima K,Kita M,Suzuki K,Senda M,Nakamoto Y,Sugimura K.Prognostic significance of SUVmax(maximum standardized uptake value)measured by[18F]FDG PET/CTin endometrial cancer.Eur J Nucl Med Mol Imaging,2012,39(5):840-845.
[30]Nakamura K,Hongo A,Kodama J,Hiramatsu Y.The measurement of SUVmaxof the primary tumor is predictive of prognosis for patients withendometrial cancer.Gynecol Oncol,2011,123(1):82-87.
[31]Nakamura K,Joja I,Fukushima C,Haruma T,Hayashi C,Kusumoto T,Seki N,Hongo A,Hiramatsu Y.The preoperative SUVmaxis superior to ADCminof the primary tumour as a predictor of disease recurrence and survival in patients with endometrial cancer.Eur J Nucl Med Mol Imaging,2013,40(1):52-60.
[32]Walentowicz-Sadlecka M,Malkowski B,Walentowicz P,Sadlecki P,Marszalek A,Pietrzak T,Grabiec M.The preoperative maximum standardized uptake value measured by18F-FDG PET/CT as an independentprognostic factor of overall survival in endometrial cancer patients.Biomed Res Int,2014,2014:234813.
[33]Liu FY,Chao A,Lai CH,Chou HH,Yen TC.Metabolic tumor volume by18F-FDG PET/CT is prognostic for stage IVB endometrial carcinoma.Gynecol Oncol,2012,125(3):566-571.
[34]Shim SH,Kim DY,Lee DY,Lee SW,Park JY,Lee JJ,Kim JH,Kim YM,Kim YT,Nam JH.Metabolic tumour volume and total lesion glycolysis,measured using preoperative18F-FDGPET/CT,predict the recurrence of endometrial cancer.BJOG,2014,121(9):1097-1106.
[2]Siegel RL,Miller KD,Jemal A.Cancer statistics,2016.CACancer J Clin,2016,66(1):7-30.
[3]Chen W,Zheng R,Baade PD,Zhang S,Zeng H,Bray F,Jemal A,Yu XQ,He J.Cancer statistics in China,2015.CACancer J Clin,2016,66(2):115-132.
[4]Ascher SM,Reinhold C.Imaging of cancer of the endometrium.Radiol Clin North Am,2002,40(3):563-576.
[5]Lewin SN,Herzog TJ,Barrena Medel NI,Deutsch I,Burke WM,Sun X,Wright JD.Comparative performance of the 2009international Federation of gynecology and obstetrics'stagingsystem for uterine corpus cancer.Obstet Gynecol,2010,116(5):1141-1149.
[6]Tirumani SH,Shanbhogue AK,Prasad SR.Current concepts in the diagnosis and management of endometrial and cervical carcinomas.Radiol Clin North Am,2013,51(6):1087-1110.
[7]Lerman H,Metser U,Grisaru D,Fishman A,Lievshitz G,E-ven-Sapir E.Normal and abnormal18F-FDG endometrial and ovarian uptake in pre-and postmenopausal patients:assessment by PET/CT.J Nucl Med,2004,45(2):266-271.
[8]Liu Y.Benign ovarian and endometrial uptake on FDG PET-CT:patterns and pitfalls.Ann Nucl Med,2009,23(2):107-112.
[9]Nishizawa S,Inubushi M,Okada H.Physiological 18F-FDG uptake in the ovaries and uterus of healthy female volunteers.Eur JNucl Med Mol Imaging,2005,32(5):549-556.
[10]Kim SK,Kang KW,Roh JW,Sim JS,Lee ES,Park SY.Incidental ovarian18F-FDG accumulation on PET:correlation with the menstrual cycle.Eur J Nucl Med Mol Imaging,2005,32(7):757-763.
[11]刘穗玲,李小毛.分段诊断性刮宫在子宫内膜癌中应用的再认识.新医学,2011,42(11):701-704.
[12]Amit A,Person O,Keidar Z.FDG PET/CT in monitoring response to treatment in gynecological malignancies.Curr Opin Obstet Gynecol,2013,25(1):17-22.
[13]Kakhki VR,Shahriari S,Treglia G,Hasanzadeh M,Zakavi SR,Yousefi Z,Kadkhodayan S,Sadeghi R.Diagnostic performance of fluorine 18 fluorodeoxyglucose positron emission tomography imaging fordetection of primary lesion and staging of endometrial cancer patients:systematic review and meta-analysis of the literature.Int J Gynecol Cancer,2013,23(9):1536-1543.
[14]Gallego JC,Porta A,Pardo MC,Fernández C.Evaluation of myometrial invasion in endometrial cancer:comparison of diffusion-weighted magneticresonance and intraoperative frozen sections.Abdom Imaging,2014,39(5):1021-1026.
[15]Antonsen SL,Jensen LN,Loft A,Berthelsen AK,Costa J,Tabor A,Qvist I,Hansen MR,Fisker R,Andersen ES,Sperling L,Nielsen AL,Asmussen J,Hgdall E,Fag-Olsen CL,Christensen IJ,Nedergaard L,Jochumsen K,Hgdall C.MRI,PET/CT and ultrasound in the preoperative staging of endometrial cancer-a multicenter prospectivecomparative study.Gynecol Oncol,2013,128(2):300-308.
[16]Park JY,Kim EN,Kim DY,Suh DS,Kim JH,Kim YM,Kim YT,Nam JH.Comparison of the validity of magnetic resonance imaging and positron emission tomography/computedtomography in the preoperative evaluation of patients with uterine corpus cancer.Gynecol Oncol,2008,108(3):486-492.
[17]Kitajima K,Yamasaki E,Kaji Y,Murakami K,Sugimura K.Comparison of DWI and PET/CT in evaluation of lymph node metastasis in uterine cancer.World J Radiol,2012,4(5):207-214.
[18]Crivellaro C,Signorelli M,Guerra L,De Ponti E,Pirovano C,Fruscio R,Elisei F,Montanelli L,Buda A,Messa C.Tailoring systematic lymphadenectomy in high-risk clinical early stage endometrial cancer:the role of18F-FDG PET/CT.Gynecol Oncol,2013,130(2):306-311.
[19]Fischer BM,Olsen MW,Ley CD,Klausen TL,Mortensen J,Hjgaard L,Kristjansen PE.How few cancer cells can be detected by positron emission tomography?A frequent question addressedby an in vitro study.Eur J Nucl Med Mol Imaging,2006,33(6):697-702.
[20]Grisaru D,Almog B,Levine C,Metser U,Fishman A,Lerman H,Lessing JB,Even-Sapir E.The diagnostic accuracy of 18F-fluorodeoxyglucose PET/CT in patients with gynecological malignancies.Gynecol Oncol,2004,94(3):680-684.
[21]Ho L,Sheth S,Seto J.Intramuscular metastasis of endometrial carcinoma on FDG PET/CT.Clin Nucl Med,2010,35(8):607-609.
[22]Ortac F,Taskin S.Inguinal recurrence of early stage endometrial cancer after 7 months of surgical staging:the role of PET-CT in diagnosis and management.Int J Clin Oncol,2012,17(3):283-285.
[23]Nishiyama Y,Yamamoto Y,Kanenishi K,Ohno M,Hata T,Kushida Y,Haba R,Ohkawa M.Monitoring the neoadjuvant therapy response in gynecological cancer patients using FDGPET.Eur J Nucl Med Mol Imaging,2008,35(2):287-295.
[24]Sharma P,Kumar R,Singh H,Jeph S,Sharma DN,Bal C,Malhotra A.Carcinoma endometrium:role of 18-FDG PET/CT for detection of suspected recurrence.Clin Nucl Med,2012,37(7):649-655.
[25]Kadkhodayan S,Shahriari S,Treglia G,Yousefi Z,Sadeghi R.Accuracy of 18-F-FDG PET imaging in the follow up of endometrial cancer patients:systematic review andmeta-analysis of the literature.Gynecol Oncol,2013,128(2):397-404.
[26]Ozcan Kara P,Kara T,Kaya B,Kara Gedik G,Sari O.The value of FDG-PET/CT in the post-treatment evaluation of endometrial carcinoma:a comparison of PET/CT findings with conventional imaging and CA125 as a tumour marker.Rev Esp Med Nucl Imagen Mol,2012,31(5):257-260.
[27]Kitajima K,Suzuki K,Nakamoto Y,Onishi Y,Sakamoto S,Senda M,Kita M,Sugimura K.Low-dose non-enhanced CT versus full-dose contrast-enhanced CT in integrated PET/CT studies for thediagnosis of uterine cancer recurrence.Eur J Nucl Med Mol Imaging,2010,37(8):1490-1498.
[28]Antonsen SL,Loft A,Fisker R,Nielsen AL,Andersen ES,Hgdall E,Tabor A,Jochumsen K,Fag-Olsen CL,Asmussen J,Berthelsen AK,Christensen IJ,Hgdall C.SUVmaxof18FDGPET/CT as a predictor of high-risk endometrial cancer patients.Gynecol Oncol,201,129(2):298-303.
[29]Kitajima K,Kita M,Suzuki K,Senda M,Nakamoto Y,Sugimura K.Prognostic significance of SUVmax(maximum standardized uptake value)measured by[18F]FDG PET/CTin endometrial cancer.Eur J Nucl Med Mol Imaging,2012,39(5):840-845.
[30]Nakamura K,Hongo A,Kodama J,Hiramatsu Y.The measurement of SUVmaxof the primary tumor is predictive of prognosis for patients withendometrial cancer.Gynecol Oncol,2011,123(1):82-87.
[31]Nakamura K,Joja I,Fukushima C,Haruma T,Hayashi C,Kusumoto T,Seki N,Hongo A,Hiramatsu Y.The preoperative SUVmaxis superior to ADCminof the primary tumour as a predictor of disease recurrence and survival in patients with endometrial cancer.Eur J Nucl Med Mol Imaging,2013,40(1):52-60.
[32]Walentowicz-Sadlecka M,Malkowski B,Walentowicz P,Sadlecki P,Marszalek A,Pietrzak T,Grabiec M.The preoperative maximum standardized uptake value measured by18F-FDG PET/CT as an independentprognostic factor of overall survival in endometrial cancer patients.Biomed Res Int,2014,2014:234813.
[33]Liu FY,Chao A,Lai CH,Chou HH,Yen TC.Metabolic tumor volume by18F-FDG PET/CT is prognostic for stage IVB endometrial carcinoma.Gynecol Oncol,2012,125(3):566-571.
[34]Shim SH,Kim DY,Lee DY,Lee SW,Park JY,Lee JJ,Kim JH,Kim YM,Kim YT,Nam JH.Metabolic tumour volume and total lesion glycolysis,measured using preoperative18F-FDGPET/CT,predict the recurrence of endometrial cancer.BJOG,2014,121(9):1097-1106.