Rektum kanserli hastalarda lokal rekürrensi ve uzak organ metastazlarını değerlendirmede PET/BT'nin rolü
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Date
2011
Authors
Dinçer, Deniz Alpan
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Rektum kanserli hastalarda 18F-2-Floro-2-deoksi-D-glukoz pozitron emisyon tomografi/bilgisayarlı tomografi (FDG-PET/BT)'nin primer tedavi sonrası lokal rekürrensin ve uzak organ metastazlarının saptanmasında genel olarak konvansiyonel görüntüleme yöntemleri (KGY)'nden üstün olduğunu bildiren araştırmalar vardır. Ülkemizde bu konuda yapılmış araştırma yoktur. Bu retrospektif çalışmanın amacı; PET/BT'nin, rektum kanseri nedeniyle opere olmuş, kemoterapi (KT) ve/veya radyoterapi (RT) sonrasında takip edilen hastalarda lokal rekürrensi ve uzak organ metastazını saptamadaki rolünü araştırmaktır.Çalışmaya; primer tedavi sonrası rutin FDG-PET/BT değerlendirmesi için refere edilen 55 erkek ve 28 kadın toplam 83 hasta dahil edildi. Hastalar lokal rekürrens, karaciğer (KC) ve akciğer (AC) metastazı ve diğer uzak organ metastazları açısından değerlendirildi.PET/BT'nin rektum kanserli hastalarda lokal rekürrensi ve uzak organ metastazlarını değerlendirmede genel sensitivitesi %96.4, spesifitesi %90, pozitif prediktif değeri (PPD) %74, negatif prediktif değeri (NPD) %99 , doğruluk oranı %92 idi.Lokal rekürrens değerlendirmesinde PET/BT'nin sensitivitesi %95.8, spesifitesi %81.4 , PPD %67.6, NPD %97.9 , ve doğruluğu %85.5 idi.CEA seviyesi normal olan hastalarda rekürrens değerlendirmesinde PET/BT'nin genel sensitivitesi, spesifitesi, PPD, NPD, doğruluk oranı sırası ile %93, %90, %62.8, %98.6, %90.4 idi. CEA seviyesi yüksek olan hastaların PET/BT ile değerlendirmesinde genel sensitivite; %100, spesifite %66.7, PPD %69.2, NPD %100, doğruluk oranı % 81 idi. CEA seviyesi yüksek olan hastalar rekürrens açısından dikkatlice araştırılmalıdır ve FDG-PET/BT bu hastalarda KGY'nden daha doğru sonuçlara ulaşmamızı sağladı. CEA seviyesinin normal sınırlar içinde olması rekürrens olasılığını ekarte ettirmez.Çalışmamız nüks hastalık saptanmasında FDG-PET/BT'nin yüksek serum CEA ölçümünden daha hassas bir yöntem olduğunu gösterdi. Opere olmuş rektum kanserli hastalarda lokal rekürrens ve uzak organ metastazı araştırmasında FDG-PET/BT KGY ile karşılaştırıldığında üstün bir görüntüleme yöntemidir. Daha önce yapılan çalışmalarda özellikle CEA seviyesi yüksek olan ve KGY ile odak saptanamayan hastalarda FDG-PET/BT görüntülemesi önerilmekte idi. Bizim çalışmamız da CEA seviyesi yüksek olan hastalarda FDG-PET/BT KGY'ne göre çok daha doğru sonuçlara ulaşmamızı sağladı. FDG-PET/BT'nin CEA seviyesi normal olan hastalarda da önemli bir görüntüleme yöntemi olduğunu ortaya koyduk. Rektum kanserinde FDG-PET/BT ile değerlendirilecek hastaların seçiminde yüksek CEA seviyesinin bir kriter olmaması gerektiğini ve CEA seviyesi normal olan hastalarda da FDG-PET/BT'nin doğru bir görüntüleme yöntemi olduğunu bulgularımız desteklemektedir.
There are researchs that were indicated in general 18 F-2-fluoro-2-deoxy-D-glucose positron emission tomography / computed tomography (FDG-PET/CT) is superior to conventional imaging methods (CIM) in patients with rectal cancer after primary treatement in detecting local recurrens and distant organ metastasis. There is no research done on this issue in our country. The aim of this retrospective study is to investigate the role of PET/CT to detection of local recurrens and distant organ metastasis in followed patients which has been operated for rectal cancer and has been chemotherapy (CT) and / or radiotherapy (RT).55 men and 28 women in a total of 83 patients. were referred for routine evaluation of FDG-PET/BT were included to study after primary treatment. Patients were evaluated for local recurrence, hepatic (H), lung (L) and the other distant organ metastases.The overall sensitivity was %96.4, spesifity was %90, pozitif predictive value (PPV) was %74, negative predictive value (NPV) was %99, and the accuracy was %92 for PET/BT in patients with rectum cancer to evaluate local recurrens and distant organ metastasis.FDG-PET/CT sensitivity was %95.8, spesifity was %81.4, PPV was %67.6, NPV was %97.9, and accuracy was %85.5 for evaluation of local recurrens.The overall sensitivity, spesifity, PPV, NPV and accuracy were respectively %93, %90, %62.8, %98.6, %90.4 for PET/BT for detection of recurrence with normal CEA level. The overall sensitivity was %100, spesifity was %66.7, PPV was %69.2, NPV was %100, accuracy was %81 in patients with high CEA level with PET/CT evaluation. Patients with high CEA level should be investigated carefully in terms of recurrence and FDG-PET/CT allowed us to reach more accurate conclusions than CIM in these patients. CEA level within normal limits.does not exclude the possibility of recurrence.Our study showed that the detection of recurrent disease, FDG-PET/BT was more precise method than detecting high serum CEA levels. To research local recurrence and distant organ metastasis in operated patients with rectal cancer, FDG-PET/CT is a superior method than CIM. In previous studies, FDG-PET/CT imaging was recommended, especially in patients with a high level of CEA and undetectable a focus with CIM. In our study, FDG-PET/CT allowed us to reach more accurate conclusions. than CIM in patients with higher CEA levels. We have demonstrated FDG-PET/CT is also an important imaging method in patients with normal CEA levelsWe think that, in rectal cancer, high CEA level, should not be a criter for selection of evaluated patients by FDG-PET/CT and FDG-PET/CT is an accurate imaging method in patients with normal CEA levels.
There are researchs that were indicated in general 18 F-2-fluoro-2-deoxy-D-glucose positron emission tomography / computed tomography (FDG-PET/CT) is superior to conventional imaging methods (CIM) in patients with rectal cancer after primary treatement in detecting local recurrens and distant organ metastasis. There is no research done on this issue in our country. The aim of this retrospective study is to investigate the role of PET/CT to detection of local recurrens and distant organ metastasis in followed patients which has been operated for rectal cancer and has been chemotherapy (CT) and / or radiotherapy (RT).55 men and 28 women in a total of 83 patients. were referred for routine evaluation of FDG-PET/BT were included to study after primary treatment. Patients were evaluated for local recurrence, hepatic (H), lung (L) and the other distant organ metastases.The overall sensitivity was %96.4, spesifity was %90, pozitif predictive value (PPV) was %74, negative predictive value (NPV) was %99, and the accuracy was %92 for PET/BT in patients with rectum cancer to evaluate local recurrens and distant organ metastasis.FDG-PET/CT sensitivity was %95.8, spesifity was %81.4, PPV was %67.6, NPV was %97.9, and accuracy was %85.5 for evaluation of local recurrens.The overall sensitivity, spesifity, PPV, NPV and accuracy were respectively %93, %90, %62.8, %98.6, %90.4 for PET/BT for detection of recurrence with normal CEA level. The overall sensitivity was %100, spesifity was %66.7, PPV was %69.2, NPV was %100, accuracy was %81 in patients with high CEA level with PET/CT evaluation. Patients with high CEA level should be investigated carefully in terms of recurrence and FDG-PET/CT allowed us to reach more accurate conclusions than CIM in these patients. CEA level within normal limits.does not exclude the possibility of recurrence.Our study showed that the detection of recurrent disease, FDG-PET/BT was more precise method than detecting high serum CEA levels. To research local recurrence and distant organ metastasis in operated patients with rectal cancer, FDG-PET/CT is a superior method than CIM. In previous studies, FDG-PET/CT imaging was recommended, especially in patients with a high level of CEA and undetectable a focus with CIM. In our study, FDG-PET/CT allowed us to reach more accurate conclusions. than CIM in patients with higher CEA levels. We have demonstrated FDG-PET/CT is also an important imaging method in patients with normal CEA levelsWe think that, in rectal cancer, high CEA level, should not be a criter for selection of evaluated patients by FDG-PET/CT and FDG-PET/CT is an accurate imaging method in patients with normal CEA levels.
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Keywords
FDG-PET/BT, Rektum kanseri, CEA, FDG-PET/CT, Rectal cancer
Citation
Dinçer, D. A. (2011). Rektum kanserli hastalarda lokal rekürrensi ve uzak organ metastazlarını değerlendirmede PET/BT'nin rolü. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.