Nuclear Medicine and Molecular Imaging

The Korean Society of Nuclear Medicine (대한핵의학회)
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Role of FDG-PET in the Diagnosis of Recurrence and Assessment of Therapeutic Response in Cervical Cancer and Ovarian Cancer Patients: Comparison of Diagnostic Report between PET, Abdominal a and Tumor Marker

자궁경부암 및 난소암 환자 재발진단과 치료반응평가에 있어서 FDG-PET의 역할: 양전자방출단층촬영, 복부전산화단층촬영 및 종양표지자 판독의 비교 분석

  • Han, You-Mie (Department of Nuclear Medicine, Korea University College of Medicine) ;
  • Choe, Jae-Gol (Department of Nuclear Medicine, Korea University College of Medicine) ;
  • Kang, Bung-Chul (Department of Radiology, Ewha Womans University College of Medicine)
  • 한유미 (고려대학교 의과대학 핵의학교실) ;
  • 최재걸 (고려대학교 의과대학 핵의학교실) ;
  • 강병철 (이화여자대학교 의과대학 영상의학교실)
  • Published : 2008.06.30
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Abstract

Purpose: We aimed to assess the role of positron emission tomography using fluorodeoxyglucose (FDG-PET) in the diagnosis of recurrence or the assessment of therapeutic response in cervical and ovarian cancer patients through making a comparison between FDG-PET, abdominal computed tomography (CT) and serum tumor marker. Materials and methods: We included 103 cases (67 patients) performed FDG-PET and abdominal CT. There were 42 cervical cancers and 61 ovarian cancers. We retrospectively reviewed the interpretations of PET and CT images as well as the level of tumor marker. We calculated their sensitivity, specificity, positive predictive value and negative predictive value for these three modalities. And then we analyzed the differences between these three modalities. Results: Tumor recurrences were diagnosed in 37 cases (11 cervical cancers and 26 ovarian cancers). For PET, CT and tumor marker, in cervical cancer group, sensitivity was 100% (11/11), 54.5% (6/11) and 81.1% (9/11), respectively. And specificity was 93.6% (29/31), 93.6% (29/31) and 100% (31/31). In ovarian cancer group, sensitivity was 96.2% (25/26), 84.6% (22/26) and 80.8% (21/26), and specificity was 94.3% (33/35), 94.3% (33/35), 94.3% (33/35), PET was highly sensitive to detect the intraperitoneal and extraperitoneal metastasis with the help of the CT images to localize the lesions. However, CT had limitations in differentiation of the recurrent tumor from benign fibrotic tissue, identification of viable tumors at the interface of tissues, and detecting extraperitoneal lesions. Conclusion: FDG-PET can be an essential modality to detect the recurrent or residual tumors in gynecologic cancer patients because of its great field of the application and high sensitivity.

목적; 복부 전산화단층촬영(CT) 및 종양표지자와 비교를 통하여 자궁경부암 및 난소암의 재발을 진단하고 치료에 대한 반응을 평가하는데 FDG를 이용한 양전자단층촬영(PET)이 어떤 역할을 하고 있는지 알아보고 앞으로 환자의 주요 추적검사방법이 될 수 있는지에 대해 알아보고자 하였다. 대상 및 방법; 2006년 5월 1일부터 2007년 10월 31일 사이에 FDG-PET를 시행한 환자 중 비슷한 시기에 복부 CT를 시행 받은 67명 환자 103예를 대상으로 하였다(자궁경부암 42예, 난소암 51예). PET, CT 및 혈중 종양표지자에 대한 판독을 후향적으로 서로 비교하였다. 세 검사에서 모두 양성을 보이거나 추적검사상 병변이 커지거나 조직검사 및 기타 검사에서 양성을 보일 때를 재발이라고 정의하여 세 검사방법의 판독에서의 차이를 분석하였다. 자궁경부암군과 난소암군으로 나누어 PET와 복부 CT 종양 표지자에 대한 진단의 민감도, 특이도, 양성 및 음성예측도를 알아보았다. 결과; 재발로 진단된 예는 37예였다. 자궁경부암에서 재발로 진단되었던 경우가 11예(9명)였으며 민감도는 각각 100%(11/11), 54.5%(6/11), 81.1%(9/11)로 PET가 가장 높았고, 특이도는 각각 93.6%(29/31), 93.6%(29/31), 100% (31/31)로 종양표지자가 가장 높았다. 난소암의 재발 진단은 26예(15명)였으며 민감도는 각각 96.2%(25/26), 84.6% (22/26), 80.8%(21/26)로 PET가 가장 높았고, 특이도는 세 검사에서 94.3%(33/35)로 동일하였다. CT에 비하여 PET에서 복강내 전이를 6예를 더 진단하였고 4예의 종격동임파절 및 폐전이를 더 진단할 수 있었으며 2예의 쇄골상와임파절과 1예의 액와임파절의 전이를 더 진단하였다. 재발환자의 분석에서 PET는 복부 외 장기의 재발을 발견할 수 있었고 복부내 재발의 경우에도 CT보다 더 민감하게 재발부위를 찾을 수 있었던 반면 CT의 도움 없이는 정확한 위치 측정이 어려웠다. CT는 잔여종양과 양성섬유화의 구분 및 조직간의 경계부위에서 종양의 구분이 어려웠고 복부 이외 장기의 전이를 발견할 수 없었다. 결론; PET는 자궁경부암과 난소암 진단에서 CT에 비해 적용 부위가 크고 조직 대조도가 커 민감도가 높은 검사법으로서 치료 후 잔여 종양의 여부나 재발을 진단하는 데 필수적이 검사법이 될 것으로 사료된다.

Keywords

References

  1. Bodurka-Bevers D, Morris M, Eifel PJ, levenback C, Bevers MW, Lucas KR, et al. Posttherapy surveillance of women with cervical cancer: an outcomes analysis. Gynecol Oncol 2000;78:187-93 https://doi.org/10.1006/gyno.2000.5860
  2. Sugawara Y, Eisbruch A, Kosuda S, Recker BE, Kison PV, Wahl RL. Evaluation of FDG PET in patients with cervical cancer. J Nucl Med 1999;40:1125-31
  3. Kerr IG, Manji MF, Powe J, Bakheet S, Al Suhaibani H, Subhi J. Positron emission tomography for the evaluation of metastases in patients with carcinoma of the cervix: a retrospective review. Gynecol Oncol 2001;81:477-80 https://doi.org/10.1006/gyno.2001.6166
  4. Park DH, Kim KH, Park SY, Lee BH, Choi CW, chin SY. Diagnosis of recurrent uterine cervical cancer: computed tomography versus positron emission tomography. Korean J Radiol 2000;1:51-5 https://doi.org/10.3348/kjr.2000.1.1.51
  5. Belhocine T, Thille A, Fridman V, Albert A, Seidel L, Nickers P, et al. Contribution of whole-body FDG PET imaging in the management of cervical cancer. Gynecol Oncol 2002;87:90-7 https://doi.org/10.1006/gyno.2002.6769
  6. Ryu SY, Kim MH, Choi SC, Choi CW, Lee KH. Detection of early recurrence with 18F-FDG PET in patients with cervical cancer. J Nucl Med 2003;44:347-52
  7. Lai CH, Huang KG, See LC, Yen TC, Tsai CS, Chang TC, et al. Restaging of recurrent cervical carcinoma with dual-phase [18F]fluoro-2-deoxy-D-glucose positron emission tomography. Cancer 2004;100: 544-52 https://doi.org/10.1002/cncr.11928
  8. Nakamoto Y, Saga T, Ishimori T, Mamede M, Togashi K, Higuchi T, et al. Clinical value of positron emission tomography with FDG for recurrent ovarian cancer. Am J Roentgenol 2001;176:1449-54 https://doi.org/10.2214/ajr.176.6.1761449
  9. Zimny M, Siggelkow W, Schroder W, Nowak B, Biemann S, Rath W, et al. 2-[Fluorine-18]-fluoro-2-deoxy-d-glucose positron emission tomography in the diagnosis of recurrent ovarian cancer. Gynecol Oncol 2001;83:310-5 https://doi.org/10.1006/gyno.2001.6386
  10. Lawhead RA Jr, Clark DG, Smith DH, Pierce VK, Lewis JL Jr. Pelvic exenteration for recurrent or persistent gynecologic malignancies: a 10-year review of the Memorial Sloan-Kettering Cancer Center experience (1972-1981). Gynecol Oncol 1989;33: 279-82 https://doi.org/10.1016/0090-8258(89)90512-X
  11. Rutledge FN, Smith JP, Wharton JT, O'Ouinn AG. Pelvic exenteration: analysis of 296 patients. Am J Obstet Gynecol 1977; 129:881-92 https://doi.org/10.1016/0002-9378(77)90521-X
  12. Hricak H, Yu KK. Radiology in invasive cervical cancer. Am J Roentgenol 1996;167:1101-8 https://doi.org/10.2214/ajr.167.5.8911159
  13. Buy JN, Moss AA, Ghossain MA, Sciot C, Malbec L, Vadrot D, et al. Peritoneal implants from ovarian tumors: CT findings. Radiology 1988;169:691-4 https://doi.org/10.1148/radiology.169.3.3186993
  14. Prayer L, Kainz C, Kramer J, Stiglbauer R, Schurawitzki H, Baldt M, et al. CT and MR accuracy in the detection of tumor recurrence in patients treated for ovarian cancer. J Comput Assist Tomogr 1993;17:626-32 https://doi.org/10.1097/00004728-199307000-00021
  15. Silverman PM, Osborne M, Dunnick NR, Bandy LC. CT prior to second-look Operation in ovarian cancer. Am J Roentgenol 1988; 150:829-32 https://doi.org/10.2214/ajr.150.4.829
  16. Niloff JM, Bast RC Jr, Schaetzl EM, Knapp RC. Predictive value of CA 125 antigen levels in second-look procedures for ovarian cancer. Am J Obstet Gynecol 1985;151:981-6 https://doi.org/10.1016/0002-9378(85)90678-7
  17. Rose PG, Reuter KL, Nelson BE, Sirois J, Fournier L, Reale FR, et al. The impact of CA-125 on the sensitivity of abdominal /pelvic CT scan before second -look laparotomy in advanced ovarian cancer. Int J Gynecol Cancer 1996;6:213-8 https://doi.org/10.1046/j.1525-1438.1996.06030213.x
  18. Rose PG, Faulhaber P, Miraldi F, Abdul-Karim FW. Positive emission tomography for evaluating a complete clinical response in patients with ovarian or peritoneal carcinoma: correlation with second-look laparotomy. Gynecol Oncol 2001;82:17-21 https://doi.org/10.1006/gyno.2001.6246
  19. Karlan By, Hawkins R, Hoh C, Lee M, Tse N, Cane P, et al. Whole-body positron emission tomography with 2-[18F]-fluoro-2-deosy-D-glucese can detect recurrent ovarian carcinoma. Gynecol Oncol 1993;51:175-81 https://doi.org/10.1006/gyno.1993.1268
  20. Sijmons EA, Heintz AP. Second-look and second surgery: second chance or second best? Semin Surg Oncol 2000;19:54-61 https://doi.org/10.1002/1098-2388(200007/08)19:1<54::AID-SSU9>3.0.CO;2-9
  21. Minn H, Kangas, L, Knuutila V, Paul R, Sipila H. Determination of 2-fluoro-2-deoxy-D-glucose uptake and ATP level for evaluating drug effects in neoplastic cells. Res Exp Med 1991;191:27-35 https://doi.org/10.1007/BF02576657
  22. Kim S, Chung JK, Kang SB, Kim MH, Jeong JM, Lee DS, et al [18F]FDG PET as a substitute for second-look laparotomy in patients with advanced ovarian carcinoma. Eur J Nucl Med Mol Imaging 2004; 31:196-201 https://doi.org/10.1007/s00259-003-1367-y