^(18)F-FDG PET/CT诊断乳腺癌及其腋窝淋巴结转移的价值评价  

Value of ^(18)F-FDG PET/CT imaging in the detection of breast cancer and axillary lymph node metastases

作　　者：朱湘[1] 徐文贵[1] 马文超[1] 戴东[1] 朱磊[1] 宋秀宇[1] 朱研佳[1] 王健[1] 门晓媛[1] 

机构地区：[1]天津医科大学附属肿瘤医院PET-CT中心,天津300060

出　　处：《中华乳腺病杂志（电子版）》2009年第5期11-16,共6页Chinese Journal of Breast Disease(Electronic Edition)

基　　金：国家自然科学基金项目(30872954);天津市自然科学基金重点项目(08JCZDJC23700);天津市科委面上项目(07JCYBJC09300)

摘　　要：目的探讨18F-脱氧葡萄糖(18F-FDG)在诊断乳腺癌及腋窝淋巴结转移的价值。方法对34例乳腺癌患者的乳腺病灶(以健侧为对照)及腋窝淋巴结18F-FDG PET/CT显像结果进行定性分析和半定量分析,结合病理结果,计算两种方法诊断的灵敏度、特异度、准确性。两种方法诊断与病理诊断行一致性检验。对乳腺病灶恶性组及对照组组间最大标准化摄取值(SUVmax)均数的比较采用两独立样本t检验。结果两组间SUVmax均数比较显示:恶性组18F-FDG摄取高于对照组,差异有统计学意义(P=0.00)。1例为大汗腺导管内癌,系原位癌,对18F-FDG摄取不明显,PET/CT图像上未见明显结节影,目测显示0级,SUVmax为1.5。该例病灶微小,小于PET/CT5~8mm的分辨率,造成定性和半定量分析均漏诊。18F-FDG PET/CT定性分析诊断乳腺癌的灵敏度、特异度、准确性分别为97.7%、100.0%、97.9%;半定量分析以SUVmax2.0时,诊断乳腺癌的灵敏度、特异度、准确性为佳,分别为93.2%、100.0%、93.6%。定性分析与病理诊断的一致性极好,Kappa值为0.85,半定量分析与病理诊断有较好一致性,Kappa值为0.64。在腋窝淋巴结转移的诊断上,定性分析的诊断灵敏度、特异度、准确性分别为55.9%、96.1%、90.1%,半定量分析(以文献SUVmax1.8为标准)的诊断灵敏度、特异度、准确性分别为45.8%、97.0%、89.3%。两种分析诊断与病理诊均较好一致性,Kappa值分别为0.57(定性分析)和0.51(半定量分析)。结论18F-FDG PET/CT诊断乳腺恶性病灶时,以SUVmax2.0为临界值进行半定量分析诊断具有较好的诊断价值;在诊断腋窝淋巴结转移方面,定性分析和半定量分析与病理诊均有较好的一致性。Objective To investigate the value of 18F-fluorodeoxyglucose （FDG） PET/CT imaging in diagnosis of breast cancer and axillary lymph node metastases. Methods According to the pathological diagnostic results 34 breast cancer patients were recruited for the study. Their 18 F-FDG PET/CT imaging data were analyzed qualitatively by visual assessment and semi-quantitatively by calculating maximum standardized uptake values （SUVmax）. The sensitivity, specificity and accuracy of the two methods were measured, Kappa test was used for the consistency of each of the two PET/CT diagnostic methods with pathological diagnosis, and the mean of SUVmax between groups was compared using two independent samples t test. Results The comparison of the mean SUVmax between the 2 groups showed the ^18 F-FDG uptake was greater in the malignant breast lesion group than in the control group, with statistical significant difference between the three groups （P= 0. 00）. One case of pathological apocrine intraductal eareinoma, cancer in situ, was negatively uptaken by PET/CT. The qualitative analysis showed zero grade and semi-quantitative analysis showed SUVmax as 1.5, because the lesion size was so small, 〈5--8 cm, which was beyond the uptake range of PET/CT. In diagnosing breast malignancy, the diagnostic accuracy, sensitivity and specificity of ^18F-FDG PET/CT qualitative analysis was 97. 9%, 97. 7% and 100. 0%, respectively; for the semi-quantitative analysis, when the cut-off point of SUVmax was set at 2.0, the sensitivity, specificity, and accuracy was 93. 2%, 100.0% and 93.6% , respectively. The kappa value was 0. 85 for qualitative analysis, with excellent agreement, and 0. 64 for semi-quantitatively. In detecting axillary lymph node metastases, the sensitivity, specificity, and accuracy of qualitative analysis were 55. 9% , 96. 1% and 90. 1% , respectively; for semiquantitative analysis, the cut-off point of SUVmax was set at 1.8 （referenced to literature）, the sensitivity, specificity, and accuracy were 45.8% , 97.

关 键 词：乳腺肿瘤 腋窝淋巴结 氟脱氧葡萄糖 正电子发射断层显像术 体层摄影术 X线计算机 

分 类 号：R737.9[医药卫生—肿瘤]