研究目的
To determine the diagnostic utility of posttreatment surveillance whole-body 18F-FDG PET/CT in detecting local tumor recurrence, regional lymph-node metastasis, and distant metastasis in asymptomatic sinonasal cancer patients.
研究成果
Whole-body 18F-FDG PET/CT is highly accurate for detecting locoregional and distant recurrences in asymptomatic sinonasal malignancy patients post-treatment, with high sensitivity, specificity, PPV, and NPV. It significantly impacts patient management by identifying recurrences missed by endoscopy and conventional imaging. However, it should be performed at least 1 month after treatment to reduce false negatives. Further studies are needed to optimize timing and frequency, and prospective comparisons with other modalities are recommended.
研究不足
The study is retrospective, leading to potential selection bias. Various histological subtypes with different recurrence propensities may affect the results. Pathological confirmation was not available for all lesions, and some were determined by clinical or imaging follow-up only. Pretreatment 18F-FDG PET/CT was not evaluated, which could provide additional prognostic information. The use of SUV thresholds was avoided, relying on qualitative interpretation, which requires experienced readers. The study was conducted at a single institution with high expertise, which may limit generalizability. False-positive and false-negative results occur due to inflammation, small tumor size, or high background uptake.
1：Experimental Design and Method Selection:
A retrospective chart review was conducted of patients who underwent whole-body 18F-FDG PET/CT for sinonasal malignancies treated with definitive surgical resection and adjuvant radiotherapy with or without chemotherapy. The study aimed to evaluate the diagnostic accuracy of 18F-FDG PET/CT in detecting recurrences and metastases.
2：Sample Selection and Data Sources:
Eighty consecutive patients with histopathologically confirmed primary sinonasal malignancies who had undergone posttreatment whole-body 18F-FDG PET/CT examinations between January 2009 and August 2017 were included. Patients were asymptomatic with no evidence of recurrence on regular follow-up and endoscopy. Exclusion criteria included benign lesions, unsuccessful primary treatment, distant metastatic disease at pretreatment staging, sinonasal lymphoma, and inadequate follow-up.
3：List of Experimental Equipment and Materials:
A combined 18F-FDG PET/CT in-line system (Biograph Sensation 16; Siemens Medical Solutions, Malvern, PA, USA) was used for imaging. Commercially available software Syngo.Via? (Siemens Healthcare Forchheim, Germany) was used for image display and interpretation. Other materials included intravenous 18F-FDG injection, contrast agents for CT, and equipment for histological analysis.
4：Experimental Procedures and Operational Workflow:
Patients fasted for at least six hours before imaging, with blood glucose levels <150 mg/dl. 18F-FDG was injected intravenously at 3 MBq/kg, and whole-body PET/CT scans were acquired 1 hour post-injection from vertex to feet, including dedicated head and neck scans. Images were interpreted visually by an experienced radiologist, and findings were categorized as positive or negative for recurrences and metastases. Outcomes were compared with histological analysis or a minimum 12-month follow-up.
5：Data Analysis Methods:
Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using 2x2 contingency tables for each site (local recurrence, regional lymph-node metastasis, distant metastasis). Statistical analyses were performed using SPSS version 23 and Excel, with Mann-Whitney U test, Fisher's exact test, and chi-square test for comparisons.
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