Klinische Wertigkeit der FDG PET in der Diagnostik gynäkologischer Tumoren: Empfehlungen der dritten Deutschen Interdisziplinären Konsensuskonferenz, „Onko-PET III“

Abstract

- Introduction: The purpose of the 3rd Consensus Conference - PET in Oncology III was the evaluation of the present position - of FDG PET in oncology on the basis of international publications. - This study presents the data for gynecological tumors. Methods: A systematic literature research was performed in all common medical literature databases between 1997 and 2000. - All hits were manually checked and abstracts, case reports, tech- nically oriented papers and reviews were excluded from analysis. t The papers were selected using standardized quality assessment according to evidence-based medicine criteria. The selected papers were reviewed by an interdisciplinary panel of experts from oncology, radiology, radiation oncology, and nuclear medicine r and the clinical use was judged according to the following grading scheme (groups): 1a, established clinical use; 1b, clinical use r probable; 2, useful in individual cases; 3, not yet assessable owing to missing or incomplete data; 4, clinical use rare (either as inferred theoretical considerations or as demonstrated by published studies). Results: Breast cancer: Between 1997 and 2000, 21 studies with 924 patients were evaluable. The sensitivity and specificity of FDG PET for the diagnosis of breast cancer were 68%-100% and 83%-100%, respectively. Detection of primary breast cancer was classified in group 2 because of the possibility of a false-negative diagnosis especially in the case of small breast cancer and the ease of obtaining a histological diagnosis. The sensitivity of FDG PET for detection of axillary lymph node metastases was 84 - 100% with a specificity of 66% in one study and 85 - 100% in the others. Sensitivity was influenced by the number of involved lymph nodes and the tumor size of the primary lesions. Therefore, detection of axillary lymph node metastases was classified in group 1 b in patients with primary lesions > 2cm. First results indicate a high sensitivity of using FDG PET for detection of distant metastases and an early therapy monitoring. These indications were classified in group 3 because of the low number of studies. Other gynecological tumors: For the other gynecological tumors, data are as yet insufficient to enable a reliable assessment of clinical efficiency of FDG PET. Only the diagnosis of recurrence in Patients with ovarian cancer was classified in group 2. Outlook: According to the opinion of experts, the detection of axillary lymph nodes and distant metastases and therapy monitoring in breast cancer patients as well as the diagnosis of recurence in ovarian cancer are potentially useful clinical indications for FDG PET. Therefore, prospective studies with large patient groups are essential to further evaluate the benefit of FDG PET in these indications.