^(18)F-氟代脱氧葡萄糖正电子发射计算机体层显像在超声乳腺影像报告和数据系统3~5类病变中的诊断价值  

Diagnostic value of^(18)F-FDG PET/CT imaging in breast imaging reporting and data system ultrasound category 3-5 lesions

作　　者：何婷婷[1] 施彦坤 苑克慧 胡蓉蓉 黄江山 陈亮[1] 王瑞民[2] He Tingting;Shi Yankun;Yuan Kehui;Hu Rongrong;Huang Jiangshan;Chen Liang;Wang Ruimin(Department of Nuclear Medicine, Hainan General Hospital of PLA, Sanya 572013, China;Department of Nuclear Medicine, First Medical Center of PLA General Hospital, Beijing 100853, China)

机构地区：[1]解放军总医院海南医院核医学科,三亚572013 [2]解放军总医院第一医学中心核医学科,北京100853

出　　处：《中华乳腺病杂志（电子版）》2021年第1期4-10,共7页Chinese Journal of Breast Disease(Electronic Edition)

基　　金：国家自然科学基金项目(81450023);三亚市医疗卫生科技创新项目(2015YW27)。

摘　　要：目的探讨^(18)F-氟代脱氧葡萄糖正电子发射计算机体层显像(^(18)F-FDG PET/CT)在超声BI-RADS 3~5类病变中的诊断价值。方法依据纳入、排除标准,选取2012年1月至2018年10月在解放军总医院第一医学中心就诊的76例乳腺超声诊断为BI-RADS 3~5类病变(77个病变)的患者进行回顾性研究。患者均行乳腺超声BI-RADS分类及^(18)F-FDG PET/CT检查[评价指标为最大标准摄取值(SUVmax)],比较2种方法的诊断效能。2组间SUVmax的比较采用独立样本t检验,多组间SUVmax的比较采用单因素方差分析,组间两两比较采用Tamhane法。以病理诊断作为金标准,绘制ROC曲线并计算曲线下面积(AUC),应用Medcalc软件对2种方法的AUC进行比较。2种方法敏感度、特异度、阳性预测值及正确率等的比较,采用配对χ^(2)检验或χ^(2)检验。结果在超声BI-RADS 3~5类病变中,恶性病变SUVmax明显大于良性病变(7.6±4.5比1.8±0.8,t=8.30,P<0.001),并且在超声BI-RADS 4类病变中,恶性病变SUVmax也大于良性病变(6.9±4.5比1.6±0.7,t=-5.552,P<0.001)。超声BI-RADS 3、4、5类病变SUVmax分别为2.2±1.3、5.2±4.2和10.1±5.5,三者比较,差异有统计学意义(F=14.68,P<0.001),并且,随着超声BI-RADS分类程度的增加,SUVmax呈递增趋势。ROC曲线分析显示:超声BI-RADS 3~5类病变中,SUVmax的AUC值为0.931(95%CI:0.877~0.984),而超声BI-RADS分类的AUC值为0.789(95%CI:0.684~0.894),两者比较,差异有统计学意义(Z=3.044,P=0.002)。以约登指数最大值确定的SUVmax临界值为3.3,SUVmax诊断的特异度及阳性预测值分别为100%(23/23)和100%(44/44),超声BI-RADS分类诊断的特异度和阳性预测值分别为43.5%(10/23)和79.7%(51/64),两者比较,差异均有统计学意义(P<0.001;χ^(2)=10.161,P=0.001),而SUVmax的敏感度与超声BI-RADS分类相比,差异无统计学意义[81.5%(44/54)比94.4%(51/54),P=0.065]。结论在BI-RADS 3~5类病变中,^(18)F-FDG PET/CT诊断效能高于超声BI-RADS分类,在判断乳腺病变Objective To investigate the diagnostic value of 2-[fluorine 18]fluoro-2-deoxy-D-glucose(^(18)F-FDG)positron emission tomography/computed tomography(PET-CT)imaging in the breast imaging reporting and data system(BI-RADS)ultrasound category 3-5 lesions.Methods According to the inclusion and exclusion criteria,this retrospective study involved 76 patients with BI-RADS category 3-5 lesions(77 lesions)in the First Medical Center of PLA General Hospital from January 2012 to October 2018.All patients underwent^(18)F-FDG PET/CT and ultrasound examination.The diagnostic efficiency of the two methods was compared.The max standard of uptake value(SUVmax)was compared between benign and malignant lesions in BI-RADS category 3-5 lesions by independent sample t test.SUVmax was compared among different subcategory by one-way ANOVA,and the Tamhane method was used for pairwise comparison.With pathological result as golden standard,the ROC curve was drawn and the area under the curve(AUC)was calculated in the Medcalc software.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of two methods were compared by pairedχ^(2) test andχ^(2) test.Results Among BI-RADS category 3-5 lesions,SUVmax of malignant lesions was significantly higher than that of benign lesions(7.6±4.5 vs 1.8±0.8,t=8.30,P<0.001).Among BI-RADS category 4 lesions,SUVmax of malignant lesions was significantly higher than that of benign lesions(6.9±4.5 vs 1.6±0.7,t=-5.552,P<0.001).SUVmax of BI-RADS category 3,4 and 5 lesions was 2.2±1.3,5.2+4.2 and 10.1+5.5,indicating a significant difference and an increasing trend(F=14.68,P<0.001).ROC curve analysis showed that SUVmax AUC was 0.931(95%CI:0.877-0.984)for BI-RADS category 3-5 lesions and 0.789(95%CI:0.684-0.894)for BI-RADS ultrasound,indicating a significant difference(Z=3.044,P=0.002).The cut off value of SUVmax determined by the maximum Yoden index is 3.3.The specificity and positive predictive value of SUVmax were 100%(23/23)and 100%(44/44),significantly higher than th

关 键 词：乳腺肿瘤 超声检查 正电子发射断层显像术 氟代脱氧葡萄糖 乳腺影像和报告数据系统 

分 类 号：R737.9[医药卫生—肿瘤]