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首页> 外文期刊>AJR: American Journal of Roentgenology : Including Diagnostic Radiology, Radiation Oncology, Nuclear Medicine, Ultrasonography and Related Basic Sciences >MRI and PET/CT for triaging stage IB clinically operable cervical cancer to appropriate therapy: decision analysis to assess patient outcomes.
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MRI and PET/CT for triaging stage IB clinically operable cervical cancer to appropriate therapy: decision analysis to assess patient outcomes.

机译：MRI和PET / CT用于将IB期临床可手术宫颈癌分门别类以进行适当治疗：评估患者预后的决策分析。

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OBJECTIVE: We evaluated the ability of pretreatment MRI and PET/CT to improve outcomes for patients with clinically staged International Federation of Gynecology and Obstetrics (FIGO) IB cervical cancer. MATERIALS AND METHODS: We developed a decision-analytic model to predict outcomes for a hypothetical patient cohort with FIGO IB cervical cancer who underwent pretreatment MRI, PET/CT, MRI and PET/CT, or no further imaging (direct pursuance of surgery). The model incorporated imaging performance, underlying parametrial extension and lymph node involvement, surgery and chemoradiation treatment options, and survival penalties from incorrect assessment of disease extent. Three outcomes were compared: 5-year overall survival, percentage of patients receiving correct primary therapy, and percentage of patients spared "trimodality therapy" (surgery followed by chemoradiation). Sensitivity analysis was performed to assess the effects of model uncertainty on outcomes. RESULTS: The preferred imaging strategy depended on the outcome studied. Five-year overall survival was comparable across strategies but was highest with the no-imaging strategy (92.37%) and with PET/CT (92.36%) and lowest with MRI (92.30%). Triage to correct primary therapy was highest with PET/CT (89.27%) and lowest with MRI (68.21%). Avoidance of trimodality therapy was highest with combined MRI and PET/CT (95.01%) and lowest with the no-imaging strategy (82.32%). Results were somewhat sensitive to imaging test performance characteristics but stable across most parameter ranges tested. CONCLUSION: Pretreatment imaging of FIGO IB cervical cancer patients can optimize triage to appropriate therapy. Although imaging does not appear to improve survival, PET/CT maximizes patient triage to correct therapy, and combined MRI and PET/CT spares the most patients unnecessary trimodality therapy.
机译：目的：我们评估了国际临床妇产科联合会（FIGO）IB子宫颈癌患者进行MRI和PET / CT预处理以改善预后的能力。材料和方法：我们开发了一个决策分析模型，以预测假设的患有FIGO IB子宫颈癌的患者的结局，这些患者接受了MRI，PET / CT，MRI和PET / CT的预处理，或者没有进一步的影像学检查（直接进行手术）。该模型包括影像学表现，潜在的子宫旁扩张和淋巴结受累，手术和化学放疗选择以及对疾病程度的不正确评估而导致的生存惩罚。比较了三个结果：5年总生存率，接受正确的主要疗法的患者百分比以及未接受“三联疗法”（手术后进行化学放疗）的患者百分比。进行敏感性分析以评估模型不确定性对结果的影响。结果：首选的成像策略取决于研究的结果。各种策略的五年总体生存率相当，但无影像策略最高（92.37％），PET / CT最高（92.36％），MRI最低（92.30％）。 PET / CT对初次治疗的分类最高（89.27％），而MRI最低（68.21％）。 MRI和PET / CT联合使用避免三联疗法的发生率最高（95.01％），而无成像策略的发生率最低（82.32％）。结果对成像测试性能特征有些敏感，但在大多数测试参数范围内都保持稳定。结论：FIGO IB宫颈癌患者的预处理成像可以优化分类以进行适当的治疗。尽管影像学似乎并未改善生存率，但PET / CT可以最大程度地分流患者以进行正确的治疗，而MRI和PET / CT的结合可为大多数患者节省不必要的三联疗法。

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