氟代脱氧葡萄糖 PET－CT 联合病理活检对鼻咽癌放疗后残存肿瘤的诊断价值  

Value of FDG PET-CT associated with pathology in diagnosing residual tumor in patients with nasopharyngeal carcinoma after radiotherapy

作　　者：陈露斯[1] 张宁[1] 王颖[2] 冼伟均[2] 胡维维[3] 卫光宇[1] 

机构地区：[1]佛山市第一人民医院肿瘤中心放疗科,528000 [2]佛山市第一人民医院肿瘤中心核医学科,528000 [3]佛山市第一人民医院肿瘤中心病理科,528000

出　　处：《中华肿瘤杂志》2015年第3期213-215,共3页Chinese Journal of Oncology

摘　　要：目的：探讨早期检测鼻咽癌放疗后残存肿瘤病灶的合理方法。方法回顾性分析47例鼻咽癌放疗后原发灶残存患者的临床和随访资料。所有患者在放疗后2周内行磁共振成像（ MRI）和氟代脱氧葡萄糖（ FDG） PET－CT检查，并对残留病灶行多点活检。复发诊断根据再次活检结果。结果47例患者经10～42个月随访，肿瘤复发3例，残存肿瘤完全消退44例。MRI、FDGPET－CT和病理活检对诊断残存肿瘤的特异度分别为9．1％、77．3％和95．5％，差异有统计学意义（P＜0．001）；准确率分别为14．9％、78．9％和95．7％，差异有统计学意义（P＜0．001）。中重度反应组和轻度反应组的最大标准摄取值（SUVmax）分别为3．05和4．68，差异有统计学意义（P＝0．012）。42例中重度反应组患者中，无一例患者复发；5例轻度反应组患者中，有3例复发，且 SUVmax≥4，另外2例SUVmax＜4的患者在随访期间残存肿瘤消退。联合轻度反应与SUVmax≥4两项指标可提高诊断鼻咽癌放疗后残存肿瘤的特异度和准确率。结论 FDG PET－CT结合病理活检有助于尽早检出鼻咽癌放疗后的残存肿瘤。Objective To find a rational way in early detecting the residual tumor in patients with nasopharyngeal carcinoma （ NPC ） after radiotherapy.Methods A total of 47 NPC patients who were diagnosed residual tumor after radiotherapy and treated in our hospital from Dec 2009 to Aug 2012 were included in this study and their clinicopathological and follow-up data were reviewed and analyzed.The patients were checked by nasopharynx MRI, FDG PET-CT and were examined by biopsy of the residual tumors within two weeks after radiotherapy.The diagnosis of relapses was determined by pathological re-examination.Results All the 47 patients were followed up for 10-42 months.Three of them had nasopharynx relapse.The others had not tumor relapse and their residual tumors disappeared completely. The specificity of MRI, FDG PET-CT and pathological tumor response in diagnosing residual tumors were 9.1%,77.3%, and 95.5%（ P 〈0.001）.Their accuracy rates were 14.9%,78.9%, and 95.7%, respectively （P〈0.001）.The M of SUVmax in the team who had moderate and severe pathologic tumor response （team A） was 3.05 and that in the team who had mild pathologic tumor response （team B） was 4.68（P=0.012）.None of patients in the team A had nasopharynx relapse.Three patients in the team B who had SUVmax≥4 had nasopharynx relapses, and in other 2 patients who had SUVmax 〈4, the residual tumors disappeared during the following-up.The specificity and accuracy in diagnosing residual tumors were increased when mild pathologic tumor response combined with SUVmax4 were used.Conclusion PET-CT combined with pathologic tumor response is beneficial for early diagnosis of residual nasopharyngeal tumors after radiotherapy.

关 键 词：鼻咽肿瘤 正电子发射断层显像术 放疗 病理学 残存肿瘤 预后 

分 类 号：R739.63[医药卫生—肿瘤] R730.55[医药卫生—临床医学]