SPECT/CT和乳腺专用伽玛显像对乳腺癌诊断价值的对比研究  

Comparative study of SPECT/CT and breast specific gamma imaging in the diagnosis of breast cancer

作　　者：谭辉[1] 张宏伟[2] 顾宇参[1] 陈曙光[1] 侯晓广 修雁[1] 石洪成[1] 

机构地区：[1]复旦大学附属中山医院核医学科,上海200032 [2]复旦大学附属中山医院普外科,上海200032

出　　处：《复旦学报（医学版）》2015年第6期716-721,共6页Fudan University Journal of Medical Sciences

基　　金：上海卫生系统先进适宜技术推广项目(2013SY008)~~

摘　　要：目的通过与SPECT/CT显像进行比较,探讨乳腺专用伽玛显像（breast specific gamma imaging,BSGI）仪诊断乳腺癌的临床应用价值。方法回顾性研究74例因乳腺肿块或乳头溢液接受手术治疗的患者。所有患者均在术前15天内完成BSGI和SPECT/CT检查,其显像资料与术后病理结果进行对照,分别计算这两种检查方法诊断乳腺癌的灵敏度、特异性、准确性、阳性预测值和阴性预测值,诊断效能比较采用配对Fisher确切概率法,P〈0.05为差异有统计学意义。同时计算这两种检查方法对于癌灶最大径为3-15 mm和〉15 mm诊断的灵敏度,以及诊断腋窝淋巴结转移的灵敏度。结果 BSGI和SPECT/CT显像对乳腺癌诊断的灵敏度、特异性、准确性、阳性预测值、阴性预测值分别为91.8%（45/49）、80.0%（20/25）、87.8%（65/74）、90.0%（45/50）、83.3%（20/24）和77.6%（38/49）、80.0%（20/25）、78.4%（58/74）、88.4%（38/43）及64.5%（20/31）,且诊断乳腺癌的效能差异有统计学意义（χ^2=5.44,P=0.039 1）。BSGI显像对于癌灶最大径为3-15 mm和〉15mm诊断的灵敏度分别为80.0%（12/15）和97.1%（33/34）,相应的SPECT/CT显像灵敏度为60.0%（9/15）和85.3%（29/34）;BSGI和SPECT/CT显像诊断腋窝淋巴结转移的灵敏度分别为18.8%（3/16）和37.5%（6/16）。结论相对于SPECT/CT显像,BSGI提高了乳腺癌诊断的灵敏度,但其诊断腋窝淋巴结转移灵敏度较低。Objective To compare the efficiency of breast specific gamma imaging（BSGI）and SPECT/CT for the diagnosis of breast cancer. Methods Seventy-four patients with palpable breast mass or nipple discharge underwent both BSGI and SPECT/CT within15-day interval before surgery,and the result diagnoses were verified with histological examination in retrospective study.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of BSGI and SPECT/CT for diagnosing breast carcinoma were calculated respectively.Fisher exact probabilities in 2 × 2 table was applied for statistical analysis,P0.05 regarded as statistical difference.The sensitivity of BSGI and SPECT/CT for diagnosing the maximum diameter of breast cancer lesion in 10-15 mm and more than 15 mm,and for diagnosing axillary metastatic lymph nodes was calculated respectively. Results The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of BSGI and SPECT/CT was 91.8%（45/49）,80.0%（20/25）,87.8%（65/74）,90.0%（45/50）,83.3%（20/24）and77.6%（38/49）,80.0%（20/25）,78.4%（58/74）,88.4%（38/43）,64.5%（20/31）,respectively,and there was significant difference between the two methods（χ2=5.44,P=0.039）.And the sensitivity of BSGI for diagnosing the maximum diameter of breast cancer lesion in3-15 mm and more than15 mm was 80.0%（12/15）and 97.1%（33/34）respectively.The sensitivity for axillary metastatic lymph nodes was 18.8%（3/16）by BSGI,while SPECT/CT was 60.0%（9/15）and 85.3%（29/34）respectively,and37.5%（6/16）by SPECT/CT. Conclusions Compared with SPECT/CT,BSGI is a useful adjunct imaging modality with higher sensitivity for the diagnosis of breast cancer.However,it has relatively low sensitivity for diagnosing axillary metastatic lymph node.

关 键 词：乳腺癌 乳腺专用伽玛显像 SPECT/CT 

分 类 号：R817.4[医药卫生—影像医学与核医学] R737.9[医药卫生—放射医学]