18F-FDG PET/CT在乳腺癌治疗前分期中的应用价值及与其它常规影像学检查的对比研究  

The Application Value of F-FDG PET / CT in Primary Staging of Breast Cancer and the Comparative Study with Other Conventional Imaging

作　　者：林志畑 林少帆 曾锦强 黄朝华 黄锦桂 Lin Zhitian;Lin Shaofan;Zeng Jinqiang;Huang Zhaohua;Huang Jingui(PET/CT Center,Affiliated Shantou Hospital Of Sun Yat-Sen University,Shantou,Guangdong 515000;Department of Radiology,Affiliated Shantou Hospital Of Sun Yat-Sen University,Shantou,Guangdong 515000)

机构地区：[1]中山大学附属汕头中心医院PET/CT中心,广东汕头515000 [2]中山大学附属汕头中心医院医学影像科,广东汕头515000

出　　处：《现代医用影像学》2020年第10期1781-1786,共6页Modern Medical Imageology

摘　　要：目的:探讨18F-脱氧葡萄糖(FDG) PET/CT在乳腺癌治疗前临床分期中的应用价值,并与其它常规影像学检查在分期中的应用进行对比研究。方法:选取2013年3月至2019年10月在中山大学附属汕头中心医院确诊乳腺癌,并于治疗前行18F-FDG PET/CT检查病例共59例。统计PET/CT检查对病灶的检出能力;采用Kappa检验评估PET/CT分期与TNM分期的一致性;采用配对四格表资料的χ2检验将PET/CT分期结果与其它常规影像学检查方法进行对比。结果:59例病例中18F-FDG PET/CT对乳腺原发病灶均能准确检出;对淋巴结转移及远处转移的准确率、灵敏度、特异度、阳性预测值及阴性预测值较高,分别为97%、95%、100%、100%、93.3%及96.6%、100%、94.9%、90.9%及100%。在26例经手术病例中,PET/CT检查分期与病理T分期一致性一般(Kappa值=0.575,P<0.001),准确率与超声及钼靶检查对比无统计学差异(P=1.000),与病理N分期一致性较好(Kappa值=0.836,P<0.001),准确率高于超声及钼靶检查(P=0.004);在所有病例中,PET/CT检查分期与临床M分期一致性较好(Kappa值=0.926,P<0.001),准确率高于其它常规影像学检查(P=0.039)。以最终临床分期为金标准,PET/CT检查相对其它影像学检查提高分期18例,准确率85.7%(16/18),降低分期8例,准确率75%(6/8),共9例改变临床治疗方案。结论:18F-FDG PET/CT检查在治疗前乳腺癌病例中有较高的病变检出能力,检查结果分期与病理及临床分期有较好的一致性,且在N分期及M分期中优于其它常规影像学检查方法,对临床治疗方案的制定有重要的指导意义。Objective:To evaluate the value of 18F-FDG PET/CT in clinical staging of newly diagnosed breast cancer,and to compare it with other conventional image.Methods:A retrospective study was performed in 59 patients with newly diagnosed breast cancer from March 2013 to October 2019 in Affiliated Shantou Hospital Of Sun Yat-Sen University.18F-FDG PET/CT was performed before treatment.To calculate the ability of lesion detective.Using Kappa test to evaluated the consistency of PET/CT staging and clinical TNM staging. Using McNemar test to compare the accuracy rate between PET/CT and conventional image.Results:All primary lesions were accurately detected by 18F-FDG PET/CT in 59 cases. And the accuracy, sensitivity, specificity, positive predictive value and negative predictive value of lymph node metastasis and distant metastasis were 97%, 95%, 100%, 100%, 93.3% and 96.6%, 100%, 94.9%, 90.9%, 100%, respectively. In 26 cases of operation, the consistency between PET/CT staging and pathological T staging was general(kappa value = 0.575, P<0.001), and was good with pathological N staging(kappa value = 0.836, P<0.001). The accuracy rate had no statistical difference compared with ultrasound and mammography(P = 1.000) in pathological T staging,but higher in pathological N staging(P = 0.004). In all 59 cases,the consistency between PET/CT and clinical M staging was good(kappa value = 0.926, P<0.001), the accuracy rate was higher than other conventional imaging(P = 0.039). According to the final clinical staging as the gold standard, compared with other conventional imaging, PET/CT raised the staging of 18 cases, 16 of which were correct, the accuracy rate was 85.7%(16/18), 8 of which decreased the staging, 6 of which were correct, the accuracy rate was 75%(6/8), a total of 9 cases changed the clinical treatment plan according to the PET/CT result.Conclusion:18F-FDG PET/CT has a high detection ability in breast cancer cases before treatment. The results of the examination are consistent with the pathological and clinical stages,

关 键 词：乳腺癌 氟脱氧葡萄糖F18 正电子发射断层显像计算机体层摄影术 TNM分期 临床分期 

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