Značaj pozitronske emisione tomografije sa kompjuterizovanom tomografijom u evaluaciji bolesnica sa sumnjom na recidiv karcinoma grlića materice

Abstract

Ciljevi: utvrĊivanje dijagnostiĉke taĉnosti PET/CT kod bolesnica sa sumnjom na recidiv cervikalnog karcinoma, odreĊivanje stepena slaganja PET/CT i konvencionalnih vizualizacionih metoda (CT, MR), i ispitivanje prognostiĉke uloge PET/CT. Metodologija: Ova retrospektivna studija obuhvatila je 113 bolesnica upućenih na PET/CT pregled u Centar za nuklearnu medicinu sa PET, Univerzitetskog Kliniĉkog Centra Srbije, sa sumnjom na recidiv cervikalnog karcinoma, uz prethodno uraĊen CT ili MR abdomena i karlice. Minimalni period praćenja bio je 12 meseci, a nalazi PET/CT poreĊeni su sa histopatološkim nalazima ili rezultatima praćenja. Rezultati: Senzitivnost, specifiĉnost, i dijagnostiĉka taĉnost u detekciji recidiva cervikalnog karcinoma bile su 85.5%,39.7%, i 63.7%. za konvencionalni imidţing, i 98.2%, 57.9%, i 77%, za PET/CT, respektivno. Slaganje nalaza CT/MR i PET/CT bilo je prisutno u 79/113 sluĉajeva. Preţivljavanje bez progresije bolesti kod pacijentkinja sa patološkim PET/CT nalazom bilo je 22.3±2.2 meseca, naspram 51.6±4.2 meseci kod PET/CT negativnih ispitanica (p<0.001). U univarijantnoj Cox-ovoj regresionoj analizi, inicijalni stadijum bolesti, MR nalaz nakon zraĉne terapije, kao i nalaz PET/CT pokazali su se statistiĉki znaĉajnim u predikciji preţivljavanja bez progresije bolesti, meĊutim, u multivarijantnom Cox-ovom modelu, samo je PET/CT nalaz potvrĊen kao nezavisni prognostiĉki faktor (HR 5.687, 95% IP 2.400-13.472, p<0.001). Zakljuĉak: Naši rezultati ukazuju na visoku senzitivnost i dijagnostiĉku taĉnost PET/CT u detekciji relapsa cervikalnog karcinoma, uz bolju specifiĉnost u odnosu na CT/MR. Pacijentkinje sa pozitivnim PET/CT nalazom imaju kraće preţivljavanje bez progresije, a nalaz PET/CT jedini je nezavisni prognostiĉki faktor.

Aims: to evaluate diagnostic abilities of PET/CT in patients with suspected cervical carcinoma recurrence, compare it to conventional imaging (CT and MRI), and also determine the potential prognostic role of PET/CT in these patients. Methodology: This retrospective study included 113 suspected recurrent cervical cancer patients who underwent PET/CT examination in Centre for nuclear medicine with PET, University clinical centre of Serbia, all of whom had previously performed CT or MRI of abdomen and pelvis. Minimum follow-up period was 12 months, and PET/CT findings were compared to histopathology or follow-up results. Results: Sensitivity, specificity and diagnostic accuracy in cervical cancer recurrence detection were 85.5%,39.7%, and 63.7%. for conventional imaging, and 98.2%, 57.9%, and 77%, for PET/CT, respectively. Concordance of CT/MRI with PET/CT was present in 79/113 cases. Women with active lesions on PET/CT had mean progression free survival time of 22.3±2.2 months, versus 51.6±4.2 months for PET/CT negative patients (p<0.001). Univariate Cox regression analysis results indicated initial disease stage, MRI in irradiated patients and PET/CT results significant in predicting progression free survivals. However, in multivariate Cox analysis, only PET/CT was confirmed as independent prognostic factor (HR 5.687, 95% CI 2.400-13.472, p<0.001). Conclusion: Our results sugest high sensitivity and accuracy of PET/CT in recurrent cervical cancer, with better specificity comparing to CT and MRI. PET/CT positive patients have shorter progression free survival than women with normal findings, and PET/CT result is the only independent prognostic factor in suspected recurrent cervival cancer.