Positron emission tomography (PET) in malignant ovarian tumors

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ginekologia

Pozytonowa tomografia emisyjna (PET) w nowotworach złośliwych jajnika

Positron emission tomography (PET) in malignant ovarian tumors

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1 Katedra i Klinika Endokrynologii, Przemiany Materii i Chorób Wewnętrznych, UM w Poznaniu, Polska

2 Zakład Medycyny Nuklearnej, Wielkopolskie Centrum Medyczne w Poznaniu, Polska

3 Klinika Ginekologii Katedry Perinatologii i Ginekologii, Uniwersytet Medyczny w Poznaniu, Polska

Streszczenie

W ostatnich latach znacznie wzrosła dostępność do pozytonowej tomografii emisyjnej sprzężonej z tomografią komputerową (PET/CT). PET/CT z użyciem 18F-deoksyglukozy (FDG) znajduje szerokie zastosowanie w nowo- tworach złośliwych jajnika na różnych etapach postępowania.

FDG PET/CT wykazuje wysoki poziom dokładności diagnostycznej w różnicowaniu zmian łagodnych i złośliwych jajnika, przy czym w przypadku guzów o złośliwości granicznej obserwuje się wysoki odsetek wyników fałszy- wie ujemnych. Ponadto FDG PET/CT jest stosowana w niektórych ośrodkach w przedoperacyjnym stopniowaniu zaawansowania klinicznego raka jajnika oraz w określaniu rokowania u chorych na ten nowotwór, jednak dalsze badania na większych grupach pacjentek są konieczne do potwierdzenia użyteczności FDG PET/CT w tych dwóch wskazaniach. Dotychczas najlepiej udokumentowanym wskazaniem do badania FDG PET/CT jest ocena wznowy raka jajnika po leczeniu operacyjnym i chemioterapii, zwłaszcza w przypadku podwyższonych wartości CA 125 i negatywnego wyniku innych badań obrazowych.

W niniejszym artykule dokonano przeglądu zastosowań PET z użyciem FDG w nowotworach złośliwych jajnika oraz zwrócono uwagę na ograniczenia tej metody.

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Abstract

Accessibility of positron emission tomography integrated with computed tomography (PET/CT) has improved si- gnificantly in recent years. PET/CT with the use of 18F-deoxyglucose (FDG) is widely used in patients with ovarian malignancies at different stages of the management. FDG PET/CT shows high diagnostic accuracy in the diffe- rentiation of benign and malignant ovarian lesions with the exception of borderline tumors that may cause false negative results.

Otrzymano: 25.02.2013

Zaakceptowano do druku: 10.06.2013 Adres do korespondencji:

Rafał Czepczyński

Klinika Endokrynologii UM w Poznaniu Przybyszewskiego 49, 60-355 Poznań, Polska tel./fax: +48 61-8691356

e-mail: rafal.czepczynski@gmail.com

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Moreover, FDG PET/CT is used in some centers for preoperative staging and determining the prognosis of ovarian cancer. However, further studies including larger groups of patients are needed to confirm the applicability of FDG PET/CT in case of the two abovementioned indications. Until now, the best documented indication for FDG PET/

CT in patients with ovarian cancer has been the detection of recurrence, especially in subjects with elevated CA 125 marker and negative results of other imaging techniques.

This review focuses on the applicability of PET with the use of FDG in ovarian malignancies and points out to the limitations of this method.

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Tabela I. Zgodność stopniowania klinicznego nowotworów złośliwych jajnika przy pomocy CT oraz FDG PET/CT z ostatecznym stopniem zaawansowania ustalonym na podstawie laparotomii i badania histopatologicznego materiału operacyjnego.

Autorzy <RVKLGD>@ &DVWHOOXFFL>@ .LWDMLPD>@ 1DP>@

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Rycina 1. Obraz PET u chorej z wodobrzuszem w przebiegu wznowy raka jajnika.

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Wykrywanie wznowy

3UDZLH  NRELHW OHF]RQ\FK ] SRZRGX UDND MDMQLND PD

Z]QRZĊ QRZRWZRUX = WHJR Z]JOĊGX SR ]DNRĔF]HQLX OHF]HQLD

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SURZDG]DVLĊZ]DOHĪQRĞFLRGZVND]DĔ>3@

Tabela II. Czułość i swoistość PET/CT w porównaniu z innymi metodami obrazowymi w wykrywaniu wznowy raka jajnika. Skróty: Cz. – czułość, Sw. – swoistość.

Autorzy

PET/CT 86* CT MRI

Cz. Sw. Cz. Sw. Cz. Sw. Cz. Sw.

3LcchLo >27@ 83% 92% 70% 83%

Risum [24] 97% 90% 66% 90% 81% 90%

Sanli [25] 98% 100% 95% 86%

Kim [31] 73% 93% 91% 86%

Bilici [26] 96% 93% 56% 67%

Nanni [34] 88% 71%

Bristow [35] 83% 82%

3an [36] 100% 85%

Chung [37] 93% 97%

Sari [28] 96% 100%

Sironi [30] 78% 75%

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áRĞüLVZRLVWRĞüZ]DOHĪQRĞFLRGEDGDQLDZDKDVLĊZJUDQLFDFK

3LGOD&7RUD]1L1GOD05,>3@

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MDMQLNDQDSRGVWDZLHEDGDQLD¿]\NDOQHJR86*OXESRGZ\ĪV]R

Q\FKZDUWRĞFL&$1RFHQLOLZDUWRĞüGLDJQRVW\F]Qą)'*3(7

&7 &7 L 86* Z Z\NU\ZDQLX Z]QRZ\ &]XáRĞü Z\QLRVáD RG

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Z\NRQDQLH VDPHJR &7 3(7&7 Z SU]\SDGNX QHJDW\ZQHJR

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VĊQDSU]HĪ\FLHSRRSHUDFMLF\WRUHGXNF\MQHM>331@'XLZVS

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Rycina 2. Obraz PET/CT u chorej po histerektomii i chemioterapii – wznowa raka jajnika pomiędzy esicą a pętlami jelita cienkiego.

Rycina 3. Obraz PET/CT jamy brzusznej przedstawiający charakterystyczne dla raka jajnika przerzuty do sieci większej.

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Podsumowanie

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SU]HSLVDPLEDGDQLH3(7&7MHVWUHIXQGRZDQHSU]H]1DURGRZ\

)XQGXV]=GURZLDZSU]\SDGNXÄUDNDMDMQLNDZFHOXZF]HVQHJR

Z\NU\FLDQDZURWXSRUDG\NDOQ\POHF]HQLXZSU]\SDGNXZ]URVWX

VWĊĪHĔ&$1OXEQLHMHGQR]QDF]Q\FKZ\QLNyZEDGDĔREUD]R

Z\FK´

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Rycina 4. OPET/CT u chorej ze wzrostem stężenia CA 125 po leczeniu operacyjnymi i chemioterapii uwidocznił drobne ognisko przerzutowe raka jajnika przy ścianie esicy.