Nuclear Medicine and Molecular Imaging

The Korean Society of Nuclear Medicine (대한핵의학회)
권호 표지

Usefulness of FDG-PET/CT as a Diagnostic Tool for Routine Post Therapy Evaluation in Endometrial Cancer

자궁내막암의 치료 후 루틴 추적검사 방법으로서 FDG-PET/CT의 유용성

  • Lee, Shin-Jae (Department of Radiology, CHA Bundang Medical center, CHA University) ;
  • Jeon, Tae-Joo (Department of Nuclear medicine, CHA Bundang Medical center, CHA University) ;
  • Kim, Seung-Jo (Department of Gynecologic Oncology, CHA Bundang Medical center, CHA University) ;
  • Kim, Hee-Jin (Department of Radiology, CHA Bundang Medical center, CHA University) ;
  • An, Hee-Jung (Department of pathology, CHA Bundang Medical center, CHA University)
  • 이신재 (차의과학대학교 분당차병원 영상의학과) ;
  • 전태주 (차의과학대학교 분당차병원 핵의학과) ;
  • 김승조 (차의과학대학교 분당차병원 부인암 센터) ;
  • 김희진 (차의과학대학교 분당차병원 영상의학과) ;
  • 안희정 (차의과학대학교 분당차병원 병리과)
  • Published : 2009.08.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The aim of this study was to evaluate the usefulness of FDG-PET/CT as follow up imaging tool in patients with endometrial cancer after therapy. Material and Methods: One hundred one patients with endometrial cancer who underwent FDG PET/CT after the treatment of this disease were included in this study population (25-79 yr old, Mean age 50.6 yr old) and all these patients also performed various laboratory and imaging studies such as serum tumor marker, CT or MRI. The lesions having increased focal FDG uptake were classified into benign, equivocal, and malignant one according to their pattern and activity. Tumor recurrence was confirmed by histopathological results and other clinical and imaging data. Results: Among the 19 patients with 30 malignant or equivocal hot uptakes, 11 of 14 patients supposed to be malignant finding in PET/CT were proved to be tumor recurrence, while one of 5 patients with equivocal lesions were recurred malignancy, Two false negative cases were turned out to be peritoneal carcinomatosis, Estimated sensitivity, specificity and accuracy of PET/CT for diagnosis of recurrence in endometrial carcinoma after treatment were 86 %, 92 % and 91 %, respectively. Positive and negative predictive values in the same issue were 63% and 98%, respectively. Conclusion: FDG-PET/CT is useful for regular work up of endometrial carcinoma after the treatment because of its high negative predictive value as well as high sensitivity and specificity.

목적: 자궁내막암의 치료 후 루틴 추적관찰로써의 FDG-PET/ET의 유용성에 대해 알아보고자 하였다. 대상 및 방법: 자궁내막암으로 치료 받은 환자 중 2004년 1월 1일부터 2008년 1월 31일 사이에 FDG-PET/CT를 시행한 101명의 환자(25-79세, 평균 50.6세)를 대상으로 하였다. 모든 환자에서 종양표지 자와 다른 영상의학적 검사(CT, MR)에 대해서도 함께 검토하였다. FDG-PET/CT상 국소 FDG 섭취를 보인 병변을 benign, equivocal, malignant로 분류하였고, equivocal과 maliganat 병변에 대하여 조직학적 혹은 임상적으로 재발유무를 판정하였다. 결과: FDG-PET/CT상 강한 섭취를 보인 경우는 19명의 30개의 병변이었다. Malignant 섭취를 보인 환자는 14명이었고, 이중 11예가 재발로 확인되었다. Equivocal 병변을 보인 환자는 5명 이었고, 이중 1예가 재발로 확인되었다. 위음성을 보인 경우는 2예가 있었고, 모두 복강내 암종증 환자로 진단되었다. 이상의 결과를 종합하였을 때, 자궁내막암의 치료 후 재발의 평가에 대한 전반적인 결과는 예민도 86 %,특이도 92 %, 양성 예측도 63 %, 음성예측도 98 %, 그리고 정확도는 91 %였다. 결론: 자궁내막암의 치료 후 루틴 추적관찰로써 FDG-PET/ET를 시행할 경우 높은 예민도, 특이도로 재발의 진단에 도움이 될 뿐만 아니라 높은 음성 예측도로 인하여 FDG-PET/CT상 음성인 경우 불필요한 추가 검사를 피할 수 있을 것으로 기대된다.

Keywords

References

  1. Jemal A, Siegel R, Ward E. Cancer statistics, 2006. CA Cancer J Clin 2006;56:106-30 https://doi.org/10.3322/canjclin.56.2.106
  2. Annual report of gynecologic cancer registry program in Korea for 2002 (2002.1.1-2002.12.31). Korean J Obstet Gynecol 2004;47:1029-70
  3. Irvin WP, Rice L W, Berkowitz RS. Advances in the management of endometrial adenocarcinoma A review. J Reprod Med 2002;47:173-89
  4. Aalders JG, Abeler V, Kolstad P. Recurrent adenocarcinoma of the endometrium: a clinical and histopathological study of 379 patients. Gynecol Oncol 1984;17:85-103 https://doi.org/10.1016/0090-8258(84)90063-5
  5. Salvesen HB, Akslen LA, Iversen T, Iversen OE. Recurrence of endometrial carcinoma and the value of routine follow up. Br J Obstet Gynaecol 1997;104:1302-07 https://doi.org/10.1111/j.1471-0528.1997.tb10979.x
  6. Shumsky AG, Stuart GC, Brasher PM, Nation JG. Robertson DI, Sangkara S. An evaluation of routine follow-up of patients treated for endometrial carcinoma. Gynecol Oncol 1994;55:229-33 https://doi.org/10.1006/gyno.1994.1282
  7. Forstner R, Hricak H, Powell CB, Azizi L, Frankel SB, Stem JL. Ovarian cancer recurrence: value of MR imaging. Radiology 1995;196:1131-40
  8. Connor JP, Andrews JI, Anderson B, Buller RE. Computed tomography in endometrial carcinoma. Obstet Gynecol 2000;95:692-6 https://doi.org/10.1016/S0029-7844(99)00626-2
  9. Cherchi PL, Dessole S, Ruiu GA, Ambrosini G, Farina M, Capobianco G, et al. The value of serum CA 125 and association CA 125/CA 19-9 in endometrial carcinoma. Eur J Gynaecol Oncol 1999;20:315-7
  10. Rohren EM, Turkington TG, Coleman RE. Clinical applications of PET in oncology. Radiology 2004;231:305-32 https://doi.org/10.1148/radiol.2312021185
  11. Chung HH, Kim SK, Kim TH, Lee S, Kang KW, Kim JY, et al. Clinical impact of FDG-PET imaging in post-therapy surveillance of uterine celvical cancer: from diagnosis to prognosis. Gynecol Oncol 2006;103:165-70 https://doi.org/10.1016/j.ygyno.2006.02.016
  12. Ryu SY, Kim MH, Choi SC, Choi CW, Lee KH Detection of early recurrence with $^{18}$F-FOO PET in patients with cervical cancer. J Nucl Med 2003;44:347-52
  13. Antoch G, Saoudi N, Kuehl H, Dahmen G, Mueller SP, Beyer T, et al. Accuracy of whole-body dual-modality fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography (FDG-PET/CT) for tumor staging in solid tumors: comparison with CT and PET. J Clin Oncol 2004;22:4357-68 https://doi.org/10.1200/JCO.2004.08.120
  14. Metser U, Golan O, Levine CD, Even-Sapir E. Tumor lesion detection: when is integrated positron emission tomography/computed tomography more accurate than side-by-side interpretation of positron emission tomography and computed tomography. J Comput Assist Tomogr 2005;29:554-9 https://doi.org/10.1097/01.rct.0000164671.96143.c2
  15. Reinartz P, Wieres FJ, Schneider W, Schur A, Buell U. Side-byside reading of PET and CT scans in oncology: which patients might profit from integrated PET/CT. Eur J Nucl Med Mol Imaging 2004;31:1456-61 https://doi.org/10.1007/s00259-004-1593-y
  16. De Leyn P, Stroobants S, De Wever W, Lerut T, Coosemans W, Decker G, et al. Prospective comparative study of integrated positron emission tomography-computed tomography scan compared with remediastinoscopy in the assessment of residual mediastinal lymph node disease after induction chemotherapy for mediastinoscopy-proven stage IIIA-N2 Non-small-cell lung cancer: a Leuven Lung Cancer Group Study. J Clin Oncol 2006;24:3333-9 https://doi.org/10.1200/JCO.2006.05.6341
  17. Pelosi E, Messa C, Sironi S, Picchio M, Landoni C, Bettinardi V, et al. Value of integrated PET/CT for lesion localisation in cancer patients: a comparative study. Eur J Nucl Med Mol Imaging 2004;31:932-9 https://doi.org/10.1007/s00259-004-1483-3
  18. Eubank WB, Mankoff DA, Vesselle HJ, Eary JF, Schubert EK, Dunnwald LK, et al. Detection of locoregional and distant recurrences in breast cancer patients by using FDG PET. Radiographics 2002;22:5-17 https://doi.org/10.1148/rg.e5
  19. 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
  20. Jimenez-Bonilla J, Maldonado A, Morales S, Salud A, Zomeno M, Roman J, et al. Clinical impact of $^{18}$F-FDG_PET in the suspicion of recurrent ovarian carcinoma based on elevated tumor marker serum levels. Clin Positron Imaging 2000;3:231-6 https://doi.org/10.1016/S1095-0397(01)00053-X
  21. Sun SS, Chen TC, Yen RF, Shen YY, Changlai SP, Kao A Value of whole body $^{18}$F-fluoro-2-deoxyglucose positron emission tomography in the evaluation of recurrent cervical cancer. Anticancer Res 2000;21:2957-61
  22. Belhocine T, Debarsy C, Hustinx R, Willems-Foidart J. Usefulness of $^{18}F$-FDG PET in the post-therapy surveillance of endometrial carcinoma. Eur J Nucl Med Mol Imaging 2002;9:1132-9
  23. Saga T, Higashi T, Ishimori T, Mameda M, Nakamoto Y, Mukai T, et al. Clinical value of FDG-PET in the follow up of postoperative patients with endometrial cancer. Ann Nucl Med 2003;17:193-203
  24. Chao A, Chang TC, Ng KK, Hsueh S, Huang ill, Chou HH, et al. $^{18}$F-FDG PET in the management of endometrial cancer. Eur J Nucl Med Mol Imaging 2006;33:36-44 https://doi.org/10.1007/s00259-005-1876-y
  25. Kitajima K, Murakami K, Yamasaki E, Hagiwara S, Fukasawa I, Inaba N, et al. Performance of FDG-PET/CT in the diagnosis of recurrent endometrial cancer. Ann Nucl Med 2008;22:103-9 https://doi.org/10.1007/s12149-007-0087-y
  26. Chung HH, Kang WJ, Kim JW, Park NH, Song YS, Chung JK, et al. The clinical impact of [$^{18}$F]FDG PET/CT for the management of recurrent endometrial cancer: correlation with clinical and histological findings Eur J Nucl Med Mol Imaging 2008;35:1081-8 https://doi.org/10.1007/s00259-007-0687-8
  27. Kim CK, Park BK, Choi JY, Kim BG, Han H. Detection of recurrent ovarian cancer at MRI: comparison with integrated PET/CT. J Comput Assist Tomogr 2007;31:868-75 https://doi.org/10.1097/rct.0b013e31803e8c45