99Tcm-3PRGD2单光子发射计算机断层显像/CT在乳腺癌诊断中应用评价  

Value of 99Tcm-3PRGD2 SPECT/CT in diagnosing breast cancer

作　　者：梁宏伟[1] Liang Hongwei(Department of Nuclear Medicine,Second Hospital of Shanxi Medical University,Taiyuan 030012,China)

机构地区：[1]山西医科大学第二医院核医学科,太原030012

出　　处：《中国药物与临床》2020年第22期3728-3731,共4页Chinese Remedies & Clinics

摘　　要：目的分析99Tcm-3PRGD2单光子发射计算机断层显像(SPECT)/CT用于乳腺癌诊断的价值。方法选择本院2017年7月至2019年7月经临床乳腺检查或超声检查发现可疑乳腺病变的104例女性患者作为研究对象,全部患者均接受99Tcm-3PRGD2 SPECT/CT检查及常规超声检查,全部入组的患者在检查后1周内接受可疑淋巴结穿刺或乳腺病灶穿刺或手术治疗,由我院病理科对组织标本进行常规处理,判定病灶病理类型。参照相关标准,观察各检查手段对乳腺恶性病变的阳性检出率,并将病理诊断结果作为金标准,对比分析99Tcm-3PRGD2 SPECT/CT与常规超声在乳腺癌诊断中的应用价值。结果104例患者共104个病灶,其中45例证实为恶性病变,主要包括浸润性导管癌、乳腺导管原位癌,病灶直径范围为0.5~4 cm,平均(2.5±1.2)cm;其他59例良性病变患者中主要检出纤维腺瘤、腺病。无论是平面显像还是SPECT断层显像,其在展开1 h、3 h时,恶性病变T/B值均高于良性病变,差异有统计学意义(P<0.05)。经ROC曲线检验发现,1 h平面显像、1 h断层显像、3 h平面显像、平面显像3 h T/B值阈值分别取1.58、3.27、1.51、2.55时,约登指数可达到最大值,可见这些数值为精确阳性阈值,因1 h平面显示准确率最高(87.2%),故将该值作为本研究T/B值阈值参考,即T/B值≥1.56时判定半定量分析阳性。将术后病理检查结果作为金标准,99Tcm-3PRGD2 SPECT/CT用于乳腺癌诊断的特异度(84.75%)优于常规超声检查(66.10%)(P<0.05),组间灵敏度比较差异无统计学意义(P>0.05);99Tcm-3PRGD2 SPECT/CT检查准确率(83.65%)略高于常规超声(74.04%)(P>0.05)。结论99Tcm-3PRGD2 SPECT/CT在乳腺癌早期筛查中极具应用价值,可作为乳腺癌早期筛查的辅助手段,相较于常规超声,该技术特异度更好,在一定程度上可减少误诊率,避免一些不必要手术活检的展开。Objective To nalyze the value of 99Tcm-3PRGD2 SPECT/CT in diagnosing breast cancer.Methods A total of 104 women with suspected breast lesions incidentally noted during clinical breast checkup or ultrasound examination in our hospital between July 2017 and July 2019 were included as study subjects.All patients received 99Tcm-3PRGD2 SPECT/CT and conventional ultrasonography.Within one week from these examinations,all included patients underwent puncture of suspected lymph nodes,or breast lesions,or surgery.The tissue specimens were routinely processed by our pathologists to determine the pathological type of the lesion.With reference to relevant diagnostic criteria,positive yields of breast malignancy were compared between the diagnostic tools.With pathological diagnosis as the gold standard,we compared the value of 99Tcm-3PRGD2 SPECT/CT vs conventional ultrasonography in diagnosing breast cancer.Results A total of 104 patients(104 lesions)were confirmed to have 45 malignant lesions dominated by invasive ductal carcinoma and ductal carcinoma in situ of the breast.The diameter of the lesions ranged from 0.5 to 4 cm,with an mean of(2.5±1.2)cm.The remaining 59 lesions were benign,dominated by fibroadenoma and adenopathy.On either planar imaging or SPECT tomography,the tumor/background(T/B)ratio of malignant lesions was higher than that of benign one at 1h and 3h of imaging,with statistically significant differences(P<0.05).ROC curve analysis showed that maximum Youden indexes were reached with a cut-off T/B ratio being 1.58 with 1h planar imaging,3.27 with 1h tomography,1.51 with 3h planar imaging,and 2.55 with 3h tomography,respectively,suggesting that these cut-off values were accurate thresholds of positivity.Given the highest accuracy(87.2%)yielded by 1h planar imaging,the T/B ratio≥1.56 was used as the reference in this study,namely,as the semi-quantitative indicator of positivity.Using post-surgical pathology as the gold standard,99Tcm-3PRGD2 SPECT/CT yielded better specificity(84.8%)in diagnosing breast canc

关 键 词：乳腺肿瘤 99Tcm-3PRGD2 SPECT/CT 诊断价值 

分 类 号：R737.9[医药卫生—肿瘤] R730.44[医药卫生—临床医学]