Baş boyun kanserlerinde 18 FDG PET/bt'nin ilk evreleme ve yeniden evrelemedeki rolü
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Dosyalar
Tarih
2011
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Selçuk Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışma sonunda amaçlanan, baş boyun kanserli hastalarda tedavi öncesi ilk evreleme ve yeniden evrelemesinde, daha önce bahsedilen avantajlara sahip 18F-FDG PET/BT görüntüleme tekniğinin, etkinliğinin ve yerinin belirlenmesi ve özellikle tedavi kararlarının verilmesinde klinik ve radyolojik yöntemlerle karşılaştırılmasıdır. PET, insan vücuduna verilen pozitron yayıcı radyonüklidler aracılığıyla organizmadaki çeşitli biyokimyasal ve metabolik olayların in vivo olarak ölçüldüğü ve tomografik olarak görüntülendiği bir görüntüleme yöntemidir. PET görüntülemede vücut içerisine verilen radyoaktif maddelerin dağılımlarının belirlenmesi (emisyon görüntüleme) amaçlanır. (96) PET'in çeşitli hastalıklar hakkında anatomik bilgi sağlayan radyolojik görüntüleme yöntemlerinden en önemli farkı fonksiyonel bir görüntüleme yöntemi olmasıdır. Fonksiyonel görüntülemede, uygun yöntem ve görüntüleme ajanları kullanılarak doku perfüzyonunun, glukoz metabolizmasının, reseptör aktivitelerinin görüntülenmesi mümkün olmaktadır (97). Günümüzde PET tarayıcısı ile birlikte aynı sistem içerisinde BT veya MR içeren, eş zamanlı olarak ve aynı pozisyonda hastanın görüntülenmesine olanak sağlayan sistemler de mevcut olup bu sistemler 'Hibrid Sistemler' olarak adlandırılmaktadır (97). Birleşik PET/BT cihazları tek bir incelemede hem FDG-PET ile metabolik bilgi hem de BT ile anatomik bilgi sağlar. Histopatolojik olarak baş boyun squamöz hücreli kanser tanısı almış, evreleme ve yeniden evreleme amaçlı Selçuk Üniversitesi, Meram Tıp Fakültesi Hastanesi Nükleer Tıp Bölümünde Kasım 2009-Aralık 2010tarihleri arasında PET/BT tetkiki yapılmış olan toplam 139 hasta çalışmaya dâhil edildi. Çalışmaya dâhil edilen 139 hastaya toplam 146 PET/BT çalışması yapıldı. Toplam 139 hastanın 36'sında PET/BT ilk evrelemede yapıldı. 103 hastada ise PET/BT yeniden evreleme amacıyla yapıldı. Toplam 139 hastada en az bir konvansiyonel görüntüleme (BT ve/veya MR) yapılmıştır. Bu çalışmaların 66'sında PET/BT doğru pozitif, 72'sinde doğru negatif, 4'ünde yanlış pozitif ve 4'ünde yanlış negatif bulundu. Konvansiyonel çalışmalarda ise 65 doğru pozitif, 64 doğru negatif, 4 yanlış pozitif ve 6 yanlış negatif olarak tespit edilmiştir. Buna göre 146 çalışma göz önünde bulundurulduğunda PET/BT sensitivite, spesifisite ve doğruluğu konvansiyonel görüntülemeden daha yüksek bulunmuştur. Oral kavite tümörlerinde PET/BT duyarlılığı %90,9 ve NÖD %94,1 olarak bulunurken, konvansiyonel görüntülemede duyarlılık %66,6 ve NÖD %76,4 olarak tespit edilmiştir. Bunun yanı sıra paranazal sinüs tümörlerinde PET/BT duyarlılığı %66,6 ve NÖD %83,3 iken, konvansiyonel görüntülemede duyarlılık %100, NÖD % 100 bulunmuştur. Larenks, nazofarenks ve primeri bilinmeyen tümörlerde PET/BT duyarlılığı, özgüllüğü ve pozitif öngörü değeri konvansiyonel görüntülemeden daha yüksek bulunmuştur, ancak primeri bilinmeyen tümör grubunda PET/BT negatif öngörü değeri % 66,6 iken, konvansiyonel görüntülemede bu değer % 100 olarak hesaplanmıştır. Tüm çalışmalar lezyon bazında analiz edildiğinde PET/BT için özgüllüğün % 94,7 duyarlılığın ise % 94,2 olduğu aynı değerlerin konvansiyonel görüntüleme yöntemleri için; sırasıyla % 94,1 ve % 91,5 olduğu ortaya konulmuştur. Cerrahinin primer tedavi olarak uygulandığı olgularda yeniden evreleme için FDG-PET ilk tercih edilecek yöntem olmamalıdır. FDG-PET bu hastalarda genel tarama için uygun olmayıp rekürrens şüphesi gösteren olgularda öncelikle endoskopik değerlendirme yapılması, daha ileri görüntüleme yöntemlerine geçilmeden önce uygun biyopsi örnekleri alınarak rekürrensin değerlendirilmesi önerilmektedir. Endoskopik değerlendirme ile birlikte yapılacak biyopsi örneklemelerinin FDG-PET'in doğruluğunu da önemli oranda arttıracağı dikkate alınmalıdır.
The aim of this study is, at the patients with head and neck cancers; the role of 18-F FDG-PET/CT at first staging and restaging to determine the place, effectiveness of it and compare it to give decision especially about the treatment management with clinical and radiologic methods. PET is an imaging thecnique that is measuring some biochemical and methabolic events in vivo, at organism given by some positron emitting radionuclids to the human body. PET imaging aims to determine the distrubution of radioactive materials which given into the body. The most important difference of PET imaging than some other radiologic methods is, being a functional imaging method. At functional imaging, it is possible to image tissue perfussion, glucose methabolism and receptor activities, by using appropriate methods and imaging agents. Currently there are some systems with PET scanner in the same system, allow to image the patient at the same position at the same time; includes CT or MR which are called ?Hybride Systems?. United PET/CT devices provides methabolic information with FDGPET and anatomical information with CT in a single examination. Totally 139 patients who have diagnosed histopathologically head and neck squamous cell carcinoma were included this study who were undergone PET/CT imaging between November 2009 and December 2010 at Nuclear Medicine Department of Selcuk University, Meram Medical Faculty. The mean age of patients was 57,3 (range 20?83). 146 PET/CT imaging performed to 139 patients who were included the study. 36 of 139 patients PET/CT imaging performed for first staging. In 103 patients PET/CT were performed for restaging. At totally 139 patients at least one conventional imaging (CT and/or MRI) were performed. At 29 of 139 patients recurrens seen with PET/CT and treatment management was changed. In these PET/CT studies, 66 true positive, 72, true negative, 4 false positive and 4 false negative values were detected. These values for conventionel thechniques were 65 true positive, 64 true negative, 4 false positive and 6 false negative. According to this study considering 146 PET/CT sensitivity, specificity and accuracy were higher than conventional imaging. In our study we found that for oral cavity tumors, sensitivity of PET/CT was 90,4% and Negative Predictive Value (NPV) was 94,1%.Same values for the conventionel imaging thechniques were 66,6% and 76,4% respectively. As well as at paranasal sinus tumors we found that PET/CT sensitivity was 66,6% and NPV was 83,3%. Same values for the conventionel imaging thechniques were 100% and 100% respectively. For the larynx, nasopharynx, and unknown primary tumors, PET/CT sensitivity, specificity and positive predictive value (PPV) was higher than the conventional views, but for unknown primary tumor group, PET/CT negative predictive value (NPV) was 66,6% whereas conventional imaging, this value was calculated as 100%. When all studies were analyzed on the basis of lesion for PET/CT, specificity was 94,7%, sensitivity was 94,2%, in the same values for conventional imaging methods, were found 94,1% and 91,5% respectivly. In the cases which performed surgery for primer treatment, FDG-PET should not be the first choice for restaging. FDG-PET is not appropriate for general screening in these patients, in cases with suspicion of recurrens it is suggested that to perform endoscopic evaluation first, before proceeding to more advanced imaging methods that to evaluate recurrens by performing appropriate biopsy samples recommended. It must be considered to performing biopsy with endoscopic evaluation can increase significantly the acuracy of FDG-PET.
The aim of this study is, at the patients with head and neck cancers; the role of 18-F FDG-PET/CT at first staging and restaging to determine the place, effectiveness of it and compare it to give decision especially about the treatment management with clinical and radiologic methods. PET is an imaging thecnique that is measuring some biochemical and methabolic events in vivo, at organism given by some positron emitting radionuclids to the human body. PET imaging aims to determine the distrubution of radioactive materials which given into the body. The most important difference of PET imaging than some other radiologic methods is, being a functional imaging method. At functional imaging, it is possible to image tissue perfussion, glucose methabolism and receptor activities, by using appropriate methods and imaging agents. Currently there are some systems with PET scanner in the same system, allow to image the patient at the same position at the same time; includes CT or MR which are called ?Hybride Systems?. United PET/CT devices provides methabolic information with FDGPET and anatomical information with CT in a single examination. Totally 139 patients who have diagnosed histopathologically head and neck squamous cell carcinoma were included this study who were undergone PET/CT imaging between November 2009 and December 2010 at Nuclear Medicine Department of Selcuk University, Meram Medical Faculty. The mean age of patients was 57,3 (range 20?83). 146 PET/CT imaging performed to 139 patients who were included the study. 36 of 139 patients PET/CT imaging performed for first staging. In 103 patients PET/CT were performed for restaging. At totally 139 patients at least one conventional imaging (CT and/or MRI) were performed. At 29 of 139 patients recurrens seen with PET/CT and treatment management was changed. In these PET/CT studies, 66 true positive, 72, true negative, 4 false positive and 4 false negative values were detected. These values for conventionel thechniques were 65 true positive, 64 true negative, 4 false positive and 6 false negative. According to this study considering 146 PET/CT sensitivity, specificity and accuracy were higher than conventional imaging. In our study we found that for oral cavity tumors, sensitivity of PET/CT was 90,4% and Negative Predictive Value (NPV) was 94,1%.Same values for the conventionel imaging thechniques were 66,6% and 76,4% respectively. As well as at paranasal sinus tumors we found that PET/CT sensitivity was 66,6% and NPV was 83,3%. Same values for the conventionel imaging thechniques were 100% and 100% respectively. For the larynx, nasopharynx, and unknown primary tumors, PET/CT sensitivity, specificity and positive predictive value (PPV) was higher than the conventional views, but for unknown primary tumor group, PET/CT negative predictive value (NPV) was 66,6% whereas conventional imaging, this value was calculated as 100%. When all studies were analyzed on the basis of lesion for PET/CT, specificity was 94,7%, sensitivity was 94,2%, in the same values for conventional imaging methods, were found 94,1% and 91,5% respectivly. In the cases which performed surgery for primer treatment, FDG-PET should not be the first choice for restaging. FDG-PET is not appropriate for general screening in these patients, in cases with suspicion of recurrens it is suggested that to perform endoscopic evaluation first, before proceeding to more advanced imaging methods that to evaluate recurrens by performing appropriate biopsy samples recommended. It must be considered to performing biopsy with endoscopic evaluation can increase significantly the acuracy of FDG-PET.
Açıklama
Anahtar Kelimeler
Kafa ve boyun neoplazmları, Head and neck neoplasms, Nazofarengeal neoplazmlar, Nasopharyngeal neoplasms, Neoplazm evreleri, Neoplasm staging, Neoplazmlar, Neoplasms, Tedavi, Treatment, Teşhis, Diagnosis
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Demirkan, A. (2011). Baş boyun kanserlerinde 18 FDG PET/bt'nin ilk evreleme ve yeniden evrelemedeki rolü. Selçuk Üniversitesi, Yayımlanmış uzmanlık tezi, Konya.