rentradВестник рентгенологии и радиологииJournal of radiology and nuclear medicine0042-46762619-0478Limited Liability Company "LUCHEVAYA DIAGNOSTIKA", Russian Association of Radiologists10.20862/0042-4676-2021-102-4-208-216rentrad-654Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL RESEARCHОценка возможности применения позитронно-эмиссионной компьютерной томографии с 18F-фтордезоксиглюкозой у пациентов с метастазами из невыявленного первичного очагаAssessment of Using 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Patients with Carcinoma of Unknown Primaryhttps://orcid.org/0000-0002-7709-977XЯременкоС. А.YaremenkoS. A.

Яременко Степан Андреевич, аспирант кафедры лучевой диагностики и лучевой терапии факультета фундаментальной медицины

Ломоносовский пр-т, 27, корп. 10, Москва, 119192

Stepan A. Yaremenko, Postgraduate, Chair of Radiodiagnostics and Radiotherapy, Faculty of Fundamental Medicine 

Lomonosovskiy prospekt, 27, korp. 10, Moscow, 119192

yaremenkosa@yandex.ruhttps://orcid.org/0000-0002-8063-4462РучьеваН. А.RuchyevaN. A.

Ручьева Наталья Александровна, к. м. н., заведующая отделением; врач-рентгенолог

ул. Щукинская, 1, Москва, 123182 

ул. Яузская, 11, стр. 1, Москва, 109028 

Natalia A. Ruchyeva, Cand. Med. Sc., Head of Department; Radiologist 

ul. Shchukinskaya, 1, Moscow, 123182

ul. Yauzskaya, 11, str. 1, Moscow, 109028

https://orcid.org/0000-0002-5649-2193СиницынВ. Е.SinitsynV. E.

Синицын Валентин Евгеньевич, д. м. н., профессор, заведующий кафедрой лучевой диагностики и лучевой терапии факультета фундаментальной медицины, заведующий отделом лучевой диагностики Медицинского научно-образовательного центра

Ломоносовский пр-т, 27, корп. 10, Москва, 119192

Valentin E. Sinitsyn, Dr. Med. Sc., Professor, Chief of Chair of Radiodiagnostics and Radiotherapy, Faculty of Fundamental Medicine, Head of Department of Radiodiagnostics, Medical Research and Educational Center 

Lomonosovskiy prospekt, 27, korp. 10, Moscow, 119192

ФГБОУ ВО «Московский государственный университет им. М.В. Ломоносова»РоссияLomonosov Moscow State UniversityRussian FederationФГБУ «Национальный медицинский исследовательский центр трансплантологии и искусственных органов им. акад. В.И. Шумакова» Минздрава России; ГБУЗ «Городская клиническая больница № 23 им. И.В. Давыдовского» Департамента здравоохранения г. МосквыРоссияShumakov National Medical Research Center for Transplantology and Artificial Organs; Davydovskiy City Clinical Hospital No. 23Russian Federation2021150920211024208216Copyright © Яременко С.А., Ручьева Н.А., Синицын В.Е., 20212021Яременко С.А., Ручьева Н.А., Синицын В.Е.Yaremenko S.A., Ruchyeva N.A., Sinitsyn V.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.russianradiology.ru/jour/article/view/654

Цели: оценить возможность применения позитронно-эмиссионной томографии в сочетании с компьютерной томографией (ПЭТ/КТ) с 18F-фтордезоксиглюкозой у пациентов с метастазами из невыявленного первичного очага (НПО); определить эффективность ПЭТ/КТ для обнаружения первичного опухолевого очага у больных с гистологически верифицированным диагнозом НПО и вклад методики ПЭТ/КТ в процесс стадирования заболевания у таких пациентов.Материал и методы. За период с сентября 2018 г. по март 2019 г. в ретроспективное исследование были включены в общей сложности 187 пациентов с диагнозом метастатазов из НПО: 64 женщины (34,2%) и 123 мужчины (65,8%). Средний возраст больных составил 61,9 ± 7,5 года. Всем пациентам перед ПЭТ/КТ была проведена пункционная биопсия как минимум одного метастатического очага и гистологически верифицирован злокачественный характер новообразования, а также выполнен ряд стандартных исследований в рамках онкопоиска для выявления природы первичного опухолевого очага.Результаты. Среди 187 больных, включенных в исследование, наблюдалось следующее распределение гистологических вариантов опухоли (по данным биопсии метастатических лимфатических узлов): 87 (46,5%) пациентов с диагнозом плоскоклеточного рака, 15 (8%) – с меланомой, 45 (24,1%) – с недифференцированной карциномой, 23 (12,3%) – с аденокарциномой, 17 (9,1%) – с недифференцированным злокачественным новообразованием. В ходе исследования первичную локализацию опухоли удалось установить у 93 (49,7%) больных, у 94 (50,3%) первичный источник не был обнаружен. Возраст пациентов в группах с выявленным и невыявленным первичным очагом после проведения ПЭТ/КТ достоверно не отличался. Новые, не выявленные ранее метастатические очаги были обнаружены при проведении ПЭТ/КТ в 93 случаях, что составило 49,7% от всей выборки. Следует отметить, что изменение стадии опухолевого процесса после проведения ПЭТ/КТ произошло в 131 наблюдении (70,1%), что было связано как с обнаружением первичной опухоли, так и с выявлением новых метастатических очагов. Изменение стадии достоверно чаще отмечалось у пациентов с найденным НПО, чем в группе с ненайденным НПО (100% против 40,4%, p < 0,001).Заключение. Применение ПЭТ/КТ позволяет точнее определить стадию онкологического процесса у значительной части больных с НПО. Во многих случаях метод позволяет выявить первичную опухоль, что, в свою очередь, оказывает влияние на тактику лечения и прогноз у данных пациентов. Проведение ПЭТ/КТ следует обязательно включать в план обследования больных с НПО.

Objectives: to assess the possibility of using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in patients with carcinoma of unknown primary (CUP); to determine the effectiveness of PET/CT for detecting a primary tumor lesion in patients with a histologically verified diagnosis of CUP and the contribution of PET/CT procedure to the process of disease staging in these patients.Material and methods. From September 2018 to March 2019, the retrospective study included a total of 187 patients (64 (34.2%) females and 123 (65.8%) males) diagnosed with CUP. The patients’ mean age was 61.9 ± 7.5 years. Before PET/CT, all the patients underwent puncture biopsy of at least one metastatic lesion, which histologically verified the malignant nature of the neoplasm. A number of conventional studies were also performed as part of an oncosearch to identify the nature of a primary cancer lesion.Results. Biopsy of lymph node metastases in 187 patients included in the study showed the following distribution according to the histological types of the tumor: 87 (46.5%) patients were diagnosed with squamous cell carcinoma, 15 (8%) with melanoma, 45 (24.1%) with undifferentiated carcinoma, 23 (12.3%) with adenocarcinoma, 17 (9.1%) with undifferentiated malignant neoplasm. The examination could identify a primary tumor site in 93 (49.7%) patients; no primary source was found in 94 (50.3%) patients. After PET/CT, there were no significant differences in the age of patients with and without CUP. PET/CT revealed new, previously undetected metastatic lesions in 93 cases, accounting for 49.7% of the entire sample. It is worth noting that after PET/CT, a change in the stage of tumor development tool place in 131 (70.1%) cases, which was associated with both the detection of the primary tumor and the identification of new metastatic lesions. The stage change was significantly more frequently observed in patients with detected CUP than in those with undetected CUP (100% vs. 40.4%; p < 0.001).Conclusion. PET/CT can more accurately determine the stage of cancer in a large proportion of patients with CUP. The technique is able to identify the primary tumor in a significant number of cases, which in turn affects treatment policy and prognosis in these patients. The use of PET/CT should be obligatorily included in the examination protocol for patients with CUP.

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The authors declare that there are no conflicts of interest present.