TY - JOUR
T1 - Evaluation of dual-timepoint18F-FDG PET/CT imaging for lymph node staging in vulvar cancer
AU - Collarino, Angela
AU - Garganese, Giorgia
AU - Olmos, Renato A. Valdés
AU - Stefanelli, Antonella
AU - Perotti, Germano
AU - Mirk, Paoletta
AU - Fragomeni, Simona M.
AU - Ieria, Francesco P.
AU - Scambia, Giovanni
AU - Giordano, Alessandro
AU - Rufini, Vittoria
PY - 2017
Y1 - 2017
N2 - This study aimed to assess the value of dual-timepoint18F-FDG PET/CT in the prediction of lymph node (LN) status in patients with invasive vulvar cancer (VC) scheduled for inguinofemoral LN dissection. Methods: From April 2013 to July 2015, all consecutive patients with VC scheduled for inguinofemoral LN dissection were prospectively enrolled. All patients underwent a preoperative whole-body18F-FDG PET/CT scan at 1 h (standard examination) and an additional scan from T11 to the groins at 3 h (delayed examination) after18F-FDG injection. On both scans, each groin was visually scored 0 or 1 concerning18F-FDG LN uptake relative to background. Semiquantitative analysis included SUVmaxand the corresponding retention index of SUVmax, measured on both scans. The optimal cutoff value of these parameters was defined using a receiveroperating- characteristic analysis. Histopathology was the standard of reference. Results: Thirty-three patients were included, with a total of 57 groins dissected and histologically evaluated. At histopathology, 21 of 57 (37%) groins contained metastatic LNs. Concerning visual score, sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were 95.2%, 75%, 96.4%, 69%, and 82.5% on standard scanning and 95.2%, 77.8%, 96.6%, 71.4%, and 84.2% on delayed scanning, respectively. At receiver-operating-characteristic analysis, sensitivity and specificity were 95.2% and 77.8% on standard and delayed18F-FDG PET/CT for an SUVmaxcutoff of greater than 1.32 and 1.88, respectively, and 95.2% and 80% for a retention index of SUVmaxcutoff of greater than 0. Conclusion: Standard18F-FDG PET/CT is an effective preoperative imaging method for the prediction of LN status in VC, allowing the prediction of pathologically negative groins and thus the selection of patients suitable for minimally invasive surgery. Delayed18F-FDG PET/CT did not improve the specificity and the positive predictive value in our series. Larger studies are needed for a further validation.
AB - This study aimed to assess the value of dual-timepoint18F-FDG PET/CT in the prediction of lymph node (LN) status in patients with invasive vulvar cancer (VC) scheduled for inguinofemoral LN dissection. Methods: From April 2013 to July 2015, all consecutive patients with VC scheduled for inguinofemoral LN dissection were prospectively enrolled. All patients underwent a preoperative whole-body18F-FDG PET/CT scan at 1 h (standard examination) and an additional scan from T11 to the groins at 3 h (delayed examination) after18F-FDG injection. On both scans, each groin was visually scored 0 or 1 concerning18F-FDG LN uptake relative to background. Semiquantitative analysis included SUVmaxand the corresponding retention index of SUVmax, measured on both scans. The optimal cutoff value of these parameters was defined using a receiveroperating- characteristic analysis. Histopathology was the standard of reference. Results: Thirty-three patients were included, with a total of 57 groins dissected and histologically evaluated. At histopathology, 21 of 57 (37%) groins contained metastatic LNs. Concerning visual score, sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were 95.2%, 75%, 96.4%, 69%, and 82.5% on standard scanning and 95.2%, 77.8%, 96.6%, 71.4%, and 84.2% on delayed scanning, respectively. At receiver-operating-characteristic analysis, sensitivity and specificity were 95.2% and 77.8% on standard and delayed18F-FDG PET/CT for an SUVmaxcutoff of greater than 1.32 and 1.88, respectively, and 95.2% and 80% for a retention index of SUVmaxcutoff of greater than 0. Conclusion: Standard18F-FDG PET/CT is an effective preoperative imaging method for the prediction of LN status in VC, allowing the prediction of pathologically negative groins and thus the selection of patients suitable for minimally invasive surgery. Delayed18F-FDG PET/CT did not improve the specificity and the positive predictive value in our series. Larger studies are needed for a further validation.
KW - 18F-FDG
KW - Aged
KW - Computer-Assisted
KW - Dual time point PET/CT
KW - FDG-retention index
KW - Female
KW - Fluorodeoxyglucose F18
KW - Groin
KW - Groin lymph node metastasis
KW - Humans
KW - Image Processing
KW - Longitudinal Studies
KW - Lymph Nodes
KW - Lymphatic Metastasis
KW - Middle Aged
KW - Neoplasm Staging
KW - Nuclear Medicine and Imaging
KW - Positron Emission Tomography Computed Tomography
KW - Predictive Value of Tests
KW - Prospective Studies
KW - Radiology
KW - Radiopharmaceuticals
KW - Vulvar Neoplasms
KW - Vulvar cancer
KW - Whole Body Imaging
KW - 18F-FDG
KW - Aged
KW - Computer-Assisted
KW - Dual time point PET/CT
KW - FDG-retention index
KW - Female
KW - Fluorodeoxyglucose F18
KW - Groin
KW - Groin lymph node metastasis
KW - Humans
KW - Image Processing
KW - Longitudinal Studies
KW - Lymph Nodes
KW - Lymphatic Metastasis
KW - Middle Aged
KW - Neoplasm Staging
KW - Nuclear Medicine and Imaging
KW - Positron Emission Tomography Computed Tomography
KW - Predictive Value of Tests
KW - Prospective Studies
KW - Radiology
KW - Radiopharmaceuticals
KW - Vulvar Neoplasms
KW - Vulvar cancer
KW - Whole Body Imaging
UR - https://publicatt.unicatt.it/handle/10807/111677
UR - https://www.scopus.com/inward/citedby.uri?partnerID=HzOxMe3b&scp=85037169837&origin=inward
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85037169837&origin=inward
U2 - 10.2967/jnumed.117.194332
DO - 10.2967/jnumed.117.194332
M3 - Article
SN - 0161-5505
VL - 58
SP - 1913
EP - 1918
JO - THE JOURNAL OF NUCLEAR MEDICINE
JF - THE JOURNAL OF NUCLEAR MEDICINE
IS - 12
ER -