18F-FDG PET/CT和18F-DOPA PET/CT在确定甲状腺髓样癌患者初始手术策略中的价值:甲状腺髓样癌术前PET/CT成像

IF 3.5 2区 医学 Q2 ONCOLOGY
Eline C Jager, Adrienne H Brouwers, Madelon J H Metman, Dilay Aykan, Lisa H de Vries, Lutske Lodewijk, Menno R Vriens, Schelto Kruijff, Thera P Links
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引用次数: 0

摘要

背景:甲状腺全切除术合并中央颈部清扫(CND)是治疗甲状腺髓样癌(MTC)的标准,而侧颈部清扫(LND)则取决于局部转移扩散情况,通常因人而异。本研究评估了术前PET/CT在诊断患者分期和指导初始手术计划中的作用,同时也探讨了颈部超声、MRI和CT的价值。方法:从两个回顾性数据库中筛选2000 - 2020年两家三级医院的所有MTC患者。所有颈部超声、mri、ct和PET/ ct报告结果:共纳入175例MTC患者(91例女性,57例遗传性MTC)。就诊时的中位年龄为52岁(IQR 38 - 62)。初始治疗包括155例(89%)、140例(80%)和59例(33%)患者的全甲状腺切除术、CND和LND。术前颈部影像学包括超声(91,52%)、MRI(33, 19%)、CT(31, 18%)。56例(32%)患者行PET/CT成像(35例18F-FDG PET/CT, 33例18F-DOPA PET/CT)。18F-FDG PET/CT、18F-DOPA PET/CT、超声、MRI和CT对中央室LNM的敏感性分别为72%、39%、6%、42%和93%。特异性分别为80%、100%、100%、71%和100%。18F-FDG PET/CT、18F-DOPA PET/CT、超声、MRI和CT对侧颈LNM的敏感性分别为89%、81%、77%、76%和75%,特异性分别为100%、100%、75%、78%和50%。23例患者影像学显示远处转移。这23例患者共进行了14次18F-FDG PET/ ct和9次18F-DOPA PET/ ct(均为6例)。除1例PET/CT外,其余均显示远处转移。结论:PET/CT是检测局部LNM的有力工具,尤其有助于确定需要进行LNM的病例,避免以后再次手术。为了准确分期中央颈部,PET可与诊断性CT相结合。最后,PET/CT检测远处转移的能力可能支持在不太可能治愈时降低手术干预的升级。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The value of 18F-FDG PET/CT and 18F-DOPA PET/CT in determining the initial surgical strategy of patients with medullary thyroid cancer : Preoperative PET/CT imaging for medullary thyroid cancer.

Background: While total thyroidectomy with central neck dissection (CND) is standard for medullary thyroid cancer (MTC), performing a lateral neck dissection (LND) depends on locoregional metastatic spread and is usually decided per individual. This study evaluated the utility of preoperative PET/CT in staging patients at diagnosis and guiding the initial surgical plan, while also exploring the value of neck ultrasound, MRI, and CT.

Methods: All MTC patients from two tertiary hospitals (2000 - 2020) were identified from two retrospective databases. All reports of neck ultrasounds, MRIs, CTs and PET/CTs < 8 months prior to primary surgery or < 4 months after MTC diagnosis were reviewed. The sensitivity and specificity of each imaging modality for locating locoregional lymph node metastases (LNM) was determined.

Results: A total of 175 MTC patients were included (91 females and 57 hereditary MTCs). Median age at presentation was 52 years (IQR 38 - 62). Initial treatment included a total thyroidectomy, CND and LND in 155 (89%), 140 (80%) and 59 (33%) patients. Preoperative imaging of the neck included ultrasound (91, 52%), MRI (33, 19%) and CT (31, 18%). PET/CT imaging was performed in 56 (32%) patients (35 18F-FDG PET/CTs and 33 18F-DOPA PET/CTs). Sensitivity for LNM in the central compartment was 72%, 39%, 6%, 42% and 93% for 18F-FDG PET/CT, 18F-DOPA PET/CT, ultrasound, MRI and CT, respectively. Respective specificity rates were 80%, 100%, 100%, 71% and 100%. Sensitivity rates for lateral neck LNM were 89%, 81%, 77%, 76% and 75%, for 18F-FDG PET/CT, 18F-DOPA PET/CT, ultrasound, MRI and CT, while specificity rates were 100%, 100%, 75%, 78% and 50%, respectively. Twenty-three patients had distant metastases on imaging. In total, 14 18F-FDG PET/CTs and 9 18F-DOPA PET/CTs were made in these 23 patients (both in six patients). All but one PET/CT showed distant metastases.

Conclusions: PET/CT is a powerful tool to detect locoregional LNM and can particularly help identify cases where LNDs are required, avoiding reoperation later on. For accurate staging of the central neck, PET may be combined with diagnostic CT. Finally, PET/CT's ability to detect distant metastases may support de-escalation of a surgical intervention when cure is unlikely.

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来源期刊
Cancer Imaging
Cancer Imaging ONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
CiteScore
7.00
自引率
0.00%
发文量
66
审稿时长
>12 weeks
期刊介绍: Cancer Imaging is an open access, peer-reviewed journal publishing original articles, reviews and editorials written by expert international radiologists working in oncology. The journal encompasses CT, MR, PET, ultrasound, radionuclide and multimodal imaging in all kinds of malignant tumours, plus new developments, techniques and innovations. Topics of interest include: Breast Imaging Chest Complications of treatment Ear, Nose & Throat Gastrointestinal Hepatobiliary & Pancreatic Imaging biomarkers Interventional Lymphoma Measurement of tumour response Molecular functional imaging Musculoskeletal Neuro oncology Nuclear Medicine Paediatric.
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