- 期刊
Usefulness of 18F-FDG PET in the Management of Recurrent Ovarian Cancer Patients with Unexplained Tumor Marker CA 125 Elevation: A Preliminary Report
氟－18-去氧葡萄糖正子斷層掃描在處理不明原因的血清CA-125腫瘤標記升高之複發性卵巢癌病患的用途：初期报告
摘要
目的：本前瞻性研究的主要目的是評估氟－18-去氧葡萄糖正子斷層掃描在經過初步完整的治療俊再複登性之卵巢癌合併不明原因的血清CA-125腫瘤標記升高之病患的臨床應用的價值。 方法：自2001年6月至2006年8月，29位卵巢癌患者合併31次掃描入案。在這31次掃描中，有30次是正子掃描和一次来自正子併電瑙斷層掃描。不明原因的血清CA-125腫瘤標記升高的定羲爲血清CA-125增加了一倍並至少一次大於35U/ml，或二次血清CA-125皆大於35U/ml，而在標準检查裡（包括全身電瑙斷層掃描）並無發現復發疾病的證據。疾病診斷的黄金標準爲組織病理學和／或臨床追踨至少6個月。正子掃描在處理上的影響是以掃描次数爲基礎的。主要目標是看正子掃描診斷效力而次要目標是看正子掃描的臨床影響力。 結果：正子掃描在檢測不明原因血清CA-125腫瘤標記升高之卵巢癌病患的復發性時，其敏感性，特異性，陽性預測值，陰性预測值和準確性分別爲84.6%，40.0%，91.7%，33.3%及77.4%。在以正子掃描爲基礎的分析上，産生的正面影響是77.4%(24/31)，而负面影響是22.6%(7/31)。在正面影響中有91.7%(22/24)被證實爲癌症復發，而8.3%(2/24)是血清CA-125腫瘤標記假性升高。在負面影響中，有42.9%(3/7)是假性陽性，而57.1%(4/7)是假性陰性。 結論：不明原因血清CA-125腫瘤標記升高之卵巢癌患者，陽性预測值高，但陰性预測值是偏低的。正子掃描的正面（價值）影響主要是尋找出復發性病灶及排除血清CA-125腫瘤標記假性升高。正子掃描的負面（價值）影響爲腸道生理吸收（但有機會利用正子併電瑙斷層掃描来使影響降到最低）及小於6毫米直徑的復發性病灶。
並列摘要
Purpose: This prospective study was to evaluate the adding value of FDG PET in ovarian cancer patients with unexplained serum CA 125 elevation after primary definitive treatment. Methods: From June 2001 to August 2006, 29 ovarian cancer patients with 31 scans were enrolled. Of the 31 scan, 30 were from PET and one was from PET/CT. The definition of unexplained tumor marker elevation was either with serum tumor marker of CA 125 increased with doubling and at least once ＞35 U/ml, or CA 125 elevation with twice ＞35 U/ml. All had no obvious evidence of disease by standard surveillance protocol, including whole body CT. The gold standard of disease status was determined by histopathology and/or clinical follow up for at least 6 months. The management impact of PET was on scan-based. The primary end point was the diagnostic efficacy and the secondary end point was the clinical impact after PET scan. Results: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of PET for relapse detection were 84.6%, 40.0%, 91.7%, 33.3% and 77.4%, respectively. On a PET scan-based analysis, the positive impact was 77.4% (24/31) and 22.6% (7/31) for negative impact. Of the positive impacts, 91.7% (22/24) were confirmed to have disease recurrence and 8.3% (2/24) were to rule out falsely CA-125 elevation. Of the negative impacts, 42.9% (3/7) had falsely positive and 57.1% (4/7) were falsely negative. Conclusion: For ovarian cancer patients with unexplained serum CA 125 elevation, the PPV of PET was high though the negative predictive value was limited. The positive impacts of PET were two. One was to find out the recurrent lesions and the other was to rule out the falsely CA 125 elevation. The negative impacts of PET were also two. One was physiological uptake at bowel, which may have chances to overcome by PET/CT and the other was small recurrent diseases with largest size of equal or under 6 mm in diameter.
延伸閱讀
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