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DOI: 10.1055/s-2001-14780
J.A.Barth Verlag in Medizinverlage Heidelberg GmbH & Co.KG
18F-FDG-Positronen-Emissions-Tomographie bei Zervixkarzinom: Erste Ergebnisse
18F-FDG-Positron-Emission-Tomography in patients with uterine cervical cancer: Preliminary resultsPublication History
Publication Date:
31 December 2001 (online)
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Zusammenfassung
Die 18F-Fluorodesoxyglucose-Positronen-Emissions-Tomographie (18F-FDG-PET) ist ein neueres Verfahren, das besonders gut zur Darstellung von malignen Tumoren geeignet ist. Ziel dieser Studie ist es, die Detektion, das metabolische Verhalten sowie die präoperative lymphonodale Ausbreitung von Zervikarzinomen mittels 18F-FDG-PET zu prüfen.
Es wurden 15 Patientinnen präoperativ mittels PET bei histologisch gesichertem Zervixkarzinom hinsichtlich der Aufnahme von 18F-FDG des Primärtumors sowie des Vorliegens einer lymphonodalen Metastasierung untersucht. Nach Hysterektomie mit pelviner und in 7 Fällen zusätzlicher paraaortaler Lymphonodektomie erfolgte der Vergleich mit den histopathologischen Ergebnissen.
Alle Primärtumoren konnten detektiert werden und wiesen einen mittleren maximalen standardisierten Aufnahmewert (standardized uptake value; SUV) von 8,0 ± 5,3 auf. 3/6 pelvine Lymphknotenmetastasen wurden mit 18F-FDG-PET gefunden; in zwei der falsch-negativen Fälle lag eine Mikrometastasierung (Metastasengröße ≤ 0,2 cm) vor. In der Untergruppe mit paraaortaler Lymphonodektomie wurde mit PET ein Lymphknotenbefall gesehen, ein zweiter Fall mit Mikrometastasierung nicht. Die diagnostische Treffsicherheit der 18F-FDG-PET beträgt 73 % für die pelvinen Lymphknotenmetastasen und 86 % für die paraaortalen Lymphknotenmetastasen.
Die Detektion von Zervixkarzinomen mittels 18F-FDG-PET ist somit zuverlässig. Zur Beurteilung einer Lymphknotenmetastasierung kann die PET unabhängig von der Größe der befallenen Lymphknoten eine metabolische Information liefern. Eine Erhöhung der diagnostischen Treffsicherheit ist zu erwarten, wenn eine kombinierte Auswertung der CT/MRT und der PET erfolgt, da sich die Aussagen der morphologischen und metabolischen Methoden ergänzen.
18F-FDG-Positron-Emission-Tomography in patients with uterine cervical cancer: Preliminary results
Summary
18F-Fluorodesoxyglucose-Positron-Emission-Tomography (18F-FDG-PET) is a novel imaging modality for malignancies. This study was initiated to define the efficiency of PET in detecting and characterizing metabolically the primaries and in preoperativly assessing of lymphonodal metastases of cervical cancer.
15 patients with histologically proven cervical carcinoma were studied with 18F-FDG-PET regarding 18F-FDG-uptake of primary tumor and evidence as well as extent of lymphonodal metastases. 18F-FDG-PET and histopathological results were compared after radical hysterectomy with pelvic and supplementary in 7 cases paraaortal lymphadenectomy. All primary tumours showed 18F-FDG accumulation and had a mean max. SUV of 8.0 ± 5.3.
3/6 lymph node metastases were obtained with 18F-FDG-PET. Micrometastases (size of metastasis ≤ 0,2 cm) were present in 2 patients with false negative PET results. Regarding the subgroup with paraaortal lymph node dissection, PET detected one patient with metastases, the other one had micrometastasis, while metastasis was not observed by PET. The accuracy of PET is 73 % for assessment of pelvic lymph nodes and 86 % for assessment of paraaortal lymph nodes.
In conclusion 18F-FDG accumulates reliably in primaries of cervical cancer. Regarding assessment of lymph node metastases PET seems to be of potential use, offering metabolic information independent of the size of metastatic lymph nodes. An improvement of accuracy can be expected if combined evaluation of morphologic and metabolic images is performed.
Schlüsselwörter
Zervixkarzinom - 18F-FDG - Positronen-Emissions-Tomographie (PET) - Lymphknoten-Staging
Key words
Uterine cervical cancer - 18F-FDG - Positron-Emission-Tomography (PET) - lymph nodes
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Dr. med. G. Kühnel
Klinik und Poliklinik für Nuklearmedizin
Universität Leipzig
Liebigstr. 20 a
D-04103 Leipzig