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Nuklearmedizin 2020; 59(06): 419-427
DOI: 10.1055/a-1221-7810
Original Article

18F-FDG PET/CT imaging of vulva cancer recurrence: A comparison of PET-derived metabolic parameters between women with and without HIV infection

18F-FDG PET/CT-Bildgebung von Vulvakarzinom-Rezidiven: Ein Vergleich der PET-Stoffwechselparameter bei Frauen mit und ohne HIV-Infektion
Kgomotso M.G. Mokoala
1   Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa
,
Ismaheel O. Lawal
1   Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa
2   Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria, South Africa
,
Thabo Lengana
1   Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa
3   KVNR Molecular Imaging, South Africa
,
Gbenga O. Popoola
4   Department of Epidemiology and Community Health, University of Ilorin, Ilorin, Nigeria
,
Tebatso M.G. Boshomane
1   Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa
,
Neo P. Mokgoro
1   Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa
,
Mariza Vorster
1   Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa
2   Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria, South Africa
,
Mike M. Sathekge
1   Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa
2   Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria, South Africa
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Abstract

Objective To assess the patterns of recurrence of vulva cancer on 18F-FDG PET/CT and to compare the 18F-FDG PET metabolic metrics in patients with and without Human Immunodeficiency Virus (HIV).

Methods Maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumour volume (MTV and total lesion glycolysis (TLG) were obtained on Flourine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) images of women referred with suspected or confirmed vulva cancer recurrence. We compared HIV-infected and HIV-uninfected patients regarding pattern disease recurrence, age at diagnosis, and the PET-derived metabolic indices.

Results We analyzed 33 patients with a mean age 50.76 ± 15.78 including 21 HIV-infected women. The majority of patients (94 %) had squamous cell carcinoma and 84.85 % were Blacks. Of the HIV-infected individuals, the median CD4 count was 526.0 cells/mm3 (IQR: 379.0–729.0). HIV infected patients were younger than the HIV uninfected at the time of diagnosis: 40.50 ± 8.87 vs 66.54 ± 9.71 respectively, p < 0.001. We found a local (vulvar) recurrence rate of 75.8 %. Nodal pelvic recurrences were higher in the HIV-infected patients than in the HIV uninfected patients (70 % vs 30 %, p = 0.027). Three patients had distant metastasis and all three were HIV-infected. There was a higher whole-body MTV and TLG among HIV-infected women compared with HIV-uninfected women, 103.39 vs 17.58 and 852.64 vs 101.79, respectively (p < 0.05 for both).

Conclusion HIV-infected women are diagnosed with vulva cancer at a younger age. HIV-infected patients had a higher rate of pelvic lymph node recurrence. There is a higher tumor burden at vulva cancer recurrence among women with HIV infection.

Zusammenfassung

Ziel Beurteilung der Rezidivierungsmuster des Vulvakarzinom in der 18F-FDG PET/CT und Vergleich der 18F-FDG PET-Stoffwechselmetriken bei Patienten mit und ohne Infektion mit HIV (Human Immunodeficiency Virus).

Methoden Maximaler Standardized Uptake Value (SUVmax), mittlerer Standardized Uptake Value (SUVmean), metabolisches Tumorvolumen (MTV und Total Lesion Glycolysis (TLG) wurden auf Flourin-18-Fluordeoxyglucose-Positronen-Emissions-Tomografie/Computertomografie (18F-FDG PET/CT)-Bildern von Frauen mit Verdacht auf oder gesicherter Diagnose eines Vulvakarzinom-Rezidivs erhalten. Wir verglichen HIV-infizierte und nicht-infizierte Patienten hinsichtlich des Musters des Rezidivierung, des Alters bei Diagnose und der metabolischen Indizes aus der PET.

Ergebnisse Wir analysierten 33 Patientinnen mit einem Durchschnittsalter von 50,76 ± 15,78 Jahren, darunter 21 HIV-infizierte Frauen. Die Mehrheit der Patienten (94 %) hatte ein Plattenepithelkarzinom und 84,85 % waren Schwarze. Bei den HIV-infizierten Personen betrug die mittlere CD4-Zahl 526,0 Zellen/mm3 (IQR: 379,0–729,0). HIV-infizierte hatten im Vergleich zu nicht-infizierten Patienten ein jüngeres Alter zum Zeitpunkt der Diagnose: 40,50 ± 8,87 vs. 66,54 ± 9,71, p < 0,001. Wir fanden eine lokale (vulväre) Rezidivrate von 75,8 %. Nodale Beckenrezidive waren bei HIV-infizierten häufiger als bei nicht-infizierten Patienten (70 % vs. 30 %, p = 0,027). Drei Patienten hatten Fernmetastasen und alle drei waren HIV-infiziert. Bei den HIV-infizierten Frauen waren Ganzkörper-MTV und TLG höher als bei den nicht-infizierten Frauen: 103,39 vs. 17,58 und 852,64 vs. 101,79 (p < 0,05 für beide).

Schlussfolgerung Bei HIV-infizierten Frauen wird Vulvakrebs in einem jüngeren Alter diagnostiziert. HIV-infizierte Patienten hatten eine höhere Rate an Rezidiven der Beckenlymphknoten. Bei Frauen mit HIV-Infektion ist die Tumorlast bei Vulvakrebs-Rezidiven höher.

Key words

vulva cancer - HIV - 18F-FDG PET/CT - SUVmax - MTV

Schlüsselwörter

Vulvakarzinom - HIV - 18F-FDG PET/CT - SUVmax - MTV


Publication History

Received: 17 June 2020

Accepted: 17 July 2020

Article published online:
01 September 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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