OBJECTIVES: The aim of the analysis was to assess the accuracy of various FDG-PET/CT parameters in staging lymph nodes after neoadjuvant chemotherapy. METHODS: In this prospective study, 74 patients with adenocarcinoma of the esophageal-gastric junction were examined by FDG-PET/CT in the course of their neoadjuvant chemotherapy given before surgical treatment. Data from the final FDG-PET/CT examinations were compared with the histology from the surgical specimens (gold standard). The accuracy was calculated for four FDG-PET/CT parameters: (1) hypermetabolic nodes, (2) large nodes, (3) large-and-medium large nodes, and (4) hypermetabolic or large nodes. RESULTS: In 74 patients, a total of 1540 lymph nodes were obtained by surgery, and these were grouped into 287 regions according to topographic origin. Five hundred and two nodes were imaged by FDG-PET/CT and were grouped into these same regions for comparison. In the analysis, (1) hypermetabolic nodes, (2) large nodes, (3) large-and-medium large nodes, and (4) hypermetabolic or large nodes identified metastases in particular regions with sensitivities of 11.6%, 2.9%, 21.7%, and 13.0%, respectively; specificity was 98.6%, 94.5%, 74.8%, and 93.6%, respectively. The best accuracy of 77.7% reached the parameter of hypermetabolic nodes. Accuracy decreased to 62.0% when also smaller nodes (medium-large) were taken for the parameter of metastases. CONCLUSIONS: FDG-PET/CT proved low sensitivity and high specificity. Low sensitivity was based on low detection rate (32.6%) when compared nodes imaged by FDG-PET/CT to nodes found by surgery, and in inability to detect micrometastases. Sensitivity increased when also medium-large LNs were taken for positive, but specificity and accuracy decreased.
- MeSH
- adenokarcinom farmakoterapie patologie chirurgie MeSH
- adjuvantní chemoterapie MeSH
- dospělí MeSH
- fluorodeoxyglukosa F18 MeSH
- gastroezofageální junkce patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lymfatické metastázy diagnostické zobrazování patologie MeSH
- nádory jícnu farmakoterapie patologie chirurgie MeSH
- neoadjuvantní terapie MeSH
- PET/CT * MeSH
- prospektivní studie MeSH
- radiofarmaka MeSH
- senioři MeSH
- senzitivita a specificita MeSH
- staging nádorů MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- fluorodeoxyglukosa F18 aplikace a dávkování MeSH
- germinální a embryonální nádory * diagnóza farmakoterapie MeSH
- germinom diagnostické zobrazování MeSH
- lidé MeSH
- nádorové biomarkery analýza MeSH
- PET/CT statistika a číselné údaje MeSH
- prognóza MeSH
- radiofarmaka aplikace a dávkování MeSH
- seminom diagnostické zobrazování farmakoterapie patologie MeSH
- testikulární nádory diagnostické zobrazování MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
18FDG-PET/CT vyšetření se v současnosti provádí na scanerech s vysokým rozlišením, s diagnostickou spolehlivostí v průkazu karcinomu pankreatu mezi 90 a 95 %. Předností metody je celotělový charakter vyšetření, který díky citlivosti metabolické informace umožní zobrazit spolehlivě vzdálená ložiska generalizace choroby. 18FDG-PET/CT vyšetření by proto mělo být součástí předoperační rozvahy, kdy může i přes svou vyšší cenu vyprodukovat vyšší relativní úsporu vložených prostředků a zlepšit pooperační výsledky tím, že vyřadí z radikální léčby nemocné, u kterých je nemoc již v okamžiku diagnózy generalizovaná.
Nowadays, high-resolution scanners are used for 18FDG-PET/CT examination, reaching adiagnostic accuracy of 90% to 95%, to diagnose pancreatic cancer. The advantage of the method is the whole-body examination range, which enables reliable detection of remote bodies of disease generalisation thanks to the high sensitivity of metabolic information. Therefore, 18FDG-PET/CT examination should be included in the pre-surgery consideration as it can lead to higher relative savings of funds despite its higher price, as well as improve post-surgery outcomesby excluding from radical treatment those patients whose disease is generalised at the time of the diagnose.
- MeSH
- adenokarcinom * radiografie MeSH
- fluorodeoxyglukosa F18 diagnostické užití MeSH
- lidé MeSH
- management nemoci MeSH
- multimodální zobrazování * ekonomika využití MeSH
- nádory slinivky břišní * radiografie MeSH
- radiofarmaka diagnostické užití MeSH
- staging nádorů metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: When applying the PET Response Criteria in Solid Tumors protocol, a threshold value based on standardized uptake value corrected to lean body mass (SUL) in liver parenchyma, or in the blood pool, is used: to metabolically specify a measurable lesion; to calculate metabolic tumor volume (mTV) and its product total lesion glycolysis (TLG); and as a limit for response measurement. The problem with using changes in glucose metabolism as a marker for response to therapy is its reproducibility on test-retest examinations. Therefore, before the evaluation of tumor treatment response, we verified our diagnostic protocol for homogeneity using the PET Response Criteria in Solid Tumors quality parameters. In addition, we analyzed the effect of the time span between examinations on the average value of SUL (SUL MEAN) in liver parenchyma at three different points: first at baseline (BL), after the first course of chemotherapy (ChT1), and finally after finishing therapy (ChT3). We also analyzed the influence of SUL MEAN variation on mTV and TLG. METHODS: Eighty-four patients with esophageal cancer were prospectively examined at BL using 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG)-PET/CT; 53 of 84 patients were examined after ChT1, 47 of 84 after ChT3, and 41 of 84 underwent all three examinations. Coefficient of variance (CV) and relative differences (RDw) were assessed for test-retest liver SUL values. The influence of liver SUL MEAN to mTV and TLG was modeled on BL examinations by artificial changes in liver SUL MEAN by ± 20%. RESULTS: No significant differences were found in test-retest liver SUL MEAN values. Comparing BL with ChT1, BL with ChT3, and ChT1 with ChT3, the CV of the liver SUL MEAN was 10.4, 10.7, and 10.3%; nevertheless, in 34.0, 38.3, and 36.6% of these examinations, respectively, the liver average SUL MEAN values exceeded the limit for inclusion in the study; that is, the difference was less than ± 0.3 U and ± 20%. The corresponding CV of blood background was 14.9, 16.5, and 17.2%. The artificial decrease of -20% in the liver SUL MEAN resulted in an increase of +43.6% in mTV and of +20.4% in TLG, whereas an increase of +20% in the liver SUL MEAN resulted in a decrease of -20.6% in mTV and -11.9% in TLG. CONCLUSION: SUL MEAN values in reference tissues (liver parenchyma or descending aorta) measured before chemotherapy did not differ significantly from those measured during chemotherapy. The CV of liver SUL MEAN was comparable to that seen in published data, but some patients had to be excluded from the study because of the individual variability of their mean liver SUL MEAN, which consequently hinders the clinical usage of mTV and TLG. Even in the standardized protocol, all potential sources of variability should be minimized.
- MeSH
- biologický transport MeSH
- dospělí MeSH
- fluorodeoxyglukosa F18 diagnostické užití metabolismus MeSH
- index tělesné hmotnosti MeSH
- játra MeSH
- lidé středního věku MeSH
- lidé MeSH
- multimodální zobrazování * MeSH
- nádory jícnu farmakoterapie metabolismus MeSH
- neoadjuvantní terapie MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- práce podpořená grantem MeSH
- MeSH
- adjuvantní chemoterapie metody využití MeSH
- diagnostické zobrazování metody využití MeSH
- fluorodeoxyglukosa F18 diagnostické užití metabolismus MeSH
- gastroezofageální junkce patologie MeSH
- glukosa diagnostické užití izolace a purifikace metabolismus MeSH
- lidé MeSH
- metastázy nádorů diagnóza MeSH
- multimodální zobrazování metody využití MeSH
- nádory jícnu diagnóza klasifikace terapie MeSH
- neoadjuvantní terapie metody využití MeSH
- pozitronová emisní tomografie metody využití MeSH
- staging nádorů metody trendy využití MeSH
- statistika jako téma MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přednášky MeSH
