Prognostic value of metabolic tumor volume and total lesion glycolysis from ¹⁸F-FDG PET/CT in lymph node metastases and risk stratification of endometrial carcinoma / 부인종양

OBJECTIVE: To investigate the prognostic value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG), measured by preoperative ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT), in risk stratification of patients with endometrial carcinoma (EC). METHODS: The patients with pathological diagnosis of EC who underwent preoperative ¹⁸F-FDG PET/CT imaging were retrospectively selected for analysis of the prognostic values of PET parameters in risk classification and lymph node metastases (LNMs). Receiver-operating-characteristic analysis was used to analyze the correlation of PET parameters cutoff values with deep myometrial invasion (MI), lymphovascular space involvement and LNM for prognostic values in risk stratification. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for detection of LNM are 83.3%, 99.7%, 90.9%, 99.5% and 99.2%, respectively. The MTV and TLG of primary lesion of EC in the patients with LNM are notably higher than those in patients without LNM, p<0.010. The MTV and TLG of the EC primary lesions in high-risk patients are significantly higher than those in low-risk patients (p<0.010), but the maximum standardized uptake value (SUVmax) is not. The MTV and TLG of primary lesions were superior to SUVmax for predicting of deep MI, LNM and high-risk of EC (p<0.005). CONCLUSION: MTV and TLG of primary lesions are more valuable in predicting risk stratification of EC patients. Preoperative ¹⁸F-FDG PET/CT imaging is useful in predicting the LNM of EC and may help guide pelvic lymphadenectomy to avoid unnecessary pelvic lymphadenectomy in EC patients with low-risk stratification.

Value of semi-quantitative indices of 68Ga-PSMA-11 PET/CT in differential diagnosis of malignant and benign prostate lesions / 中华核医学与分子影像杂志

Objective To evaluate the value of semi-quantitative indices of 68Ga-prostate specific membrane antigen (PSMA)-11 PET/CT in differentiating malignant and benign prostate lesions.Methods From November 2017 to June 2018,30 patients (age:52-86 years) who underwent 68Ga-PSMA-11 PET/CT imaging in the Third Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed,and the serum total prostate specific antigen (tPSA) and free prostate specific antigen (fPSA) were examined within 1 week before PET/CT imaging.Semi-quantitative indices of 68Ga-PSMA-11 PET/CT on prostate lesions were measured by automatic segmentation algorithm method,including PSMA-related lesion volume (VPSMA),maximum standardized uptake value (SUVmax),mean standardized uptake value (SUVmean),peak standardized uptake value (SUVpeak) and total lesion uptake value of PSMA (TLUPSMA).The indices were compared between malignant and benign prostate lesions,and the optimal cut-off values for differentiating malignant and benign prostate lesions were obtained by receiver operating characteristic (ROC) curve analysis.Results According to the pathological results,19 patients had malignant lesions and 11 were with benign diseases.The differences of tPSA,SUVmax,SUVmean SUVpeak and TLUPSMA between malignant and benign prostate lesions were statistically significant (u values:17.00-48.00,all P＜0.05),but there were no significant differences of fPSA,fPSA/tPSA and VPSMA between 2 groups (u values:64.00-99.00,all P＞0.05).The optimal cut-off value of tPSA was 18.30 μg/L for differentiating malignant and benign prostate lesions,with sensitivity of 13/17 (PSA of 2 patients were missing),specificity of 9/11 and area under curve (AUC) of 0.743.The optimal cut-off values of SUVmax,SUVmean and SUVpeak were 5.50,3.09 and 3.56,respectively,with all corresponding sensitivity of 18/19,all specificity of 9/11,and AUC of 0.902,0.907 and 0.919,respectively.The optimal cut-off value of TLUPSMA was 54.81 cm3,with sensitivity of 14/19,specificity of 9/11 and AUC of 0.804.Conclusion The semi-quantitative indices of 68Ga-PSMA-11 PET/CT are valuable for differentiating malignant and benign prostate lesions,in which SUVpeak is superior to other indices.

Application of circulating tumor cell counting in diagnosis of patients with colorectal cancer / 中华消化杂志

Objective To explore the application value of circulating tumor cell (CTC) counting in the diagnosis of patients with colorectal cancer.Methods From July to October in 2015,a total of 61 patients firstly diagnosed with colorectal cancer,at stagc] to Ⅳ were enrolled.At the same period,20 individuals (healthy volunteers or patients with benign colorectal diseases) were selected as controls.Peripheral blood (7.5 mL) was taken before therapy.Peripheral blood CTC were counted by immunomagnetic beads enrichment combined with fluorescent staining method in two hours.The positive detection rate of CTC for colorectal cancer,especially early colorectal cancer was analyzed.And the priority of combination it with carcino-embryonic antigen (CEA) was also investigated.Chi-square test,t test and rank-sum test were used for statistical analysis.Results Two patients could not be pathological staged,due to the lack of whole body imaging evaluation.There were 30 patients with colorectal cancer at early stage (stage Ⅰ to Ⅱ) and 29 patients at advanced stage (stage Ⅲ to Ⅳ).The difference in CEA level between patients at early stage and advanced stage ((3.3±1.1) μg/L vs (20.4±3.3) μg/L) was statistically significant (t=-2.74,P=0.008).The median cell number of CTC of colorectal cancer group and control group was 1 (interquartile range=4) and 0,respectively,and the difference was statistically significant (Z=2.721,P=0.007).Taken 0/7.5 mL and 5 μg/L as the cut-off value of CTC and CEA,the detection rates of CTC for colorectal cancer and early colorectal cancer were 65.6％ (40/61) and 63.3％ (19/30),respectively;the detection rates of CEA for colorectal cancer and early colorectal cancer were 29.5 ％ (18/61) and 13.3％ (4/30).When CTC combined with CEA,the detection rates for colorectal cancer and early colorectal cancer were 73.8％ (45/61) and 66.7％ (20/30),respectively.Conclusions CTC has certain detection value in colorectal cancer especially early colorectal cancer.If it combined with CEA,the detection rate is much higher.

Clinical value of 99mTc-MDP SPECT/CT whole body bone imaging in diagnosis of bone metastasis of pros-tate cancer / 实用医学杂志

Objective To investigate the clinical value of 99mTc-MDP SPECT/CT whole body bone imaging in the diagnosis of bone metastasis of prostate cancer. Methods A total of 107 cases with prostate cancer were di-agnosed by SPECT whole body bone imaging from January 2013 to November 2016. SPECT/CT imaging of some ab-normal density collective focus found in whole body bone imaging were further carried out. Six months later ,whole body bone imaging and SPECT/CT were made again for review. In all diagnosis above ,99mTc-MDP were selected as bone imaging agent. According to the results of follow-up visit clinical and imaging diagnosis ,diagnostic perfor-mance indicators of whole body bone imaging and SPECT/CT were calculated. Results The different part of whole body bone imaging and SPECT/CT in the diagnosis of bone metastases was statistically significant(x2 = 23.000, P < 0.001). The diagnosis specificity and coincidence rate of SPECT/CT for bone metastasis were 100.0% and 98.1% respectively and they were significantly higher than those of whole body bone imaging(65.0% and 80.4%respectively). The differences were statistically significant(P < 0.05). After SPECT/CT diagnosis,a total of 193 undetermined lesions were found and 83 lesions of these were final diagnosed of bone metastases. Pelvic lesions were most in bone metastases ,accounting for 50.6%. Conclusion Whole body bone imaging can effectively determine the undetermined lesions , further SPECT/CT can significantly improve the diagnostic accuracy of prostate cancer bone metastasis.