^(99)Tcm硫胶体淋巴显像在妇科肿瘤术后下肢淋巴水肿诊断中的临床应用  

Clinical application of^(99)Tcm-sulfur colloid lymphoscintigraphy in the diagnosis of lower limb lymphedema after gynecological tumor surgery

作　　者：高宇 夏晓天 胡帆 张雅婧 黄代娟[1] 曹国祥 曹卫[1] 张永学[3] 兰晓莉[1] 安锐[1] Gao Yu;Xia Xiaotian;Hu Fan;Zhang Yajing;Huang Daijuan;Cao Guoxiang;Cao Wei;Zhang Yongxue;Lan Xiaoli;An Rui(Department of Nuclear Medicine,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Nuclear Medicine,Honghu People's Hospital,Honghu 433200,China;Hubei Key Laboratory of Molecular Imaging,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院核医学科,武汉430022 [2]洪湖市人民医院核医学科,洪湖433200 [3]华中科技大学同济医学院附属协和医院分子影像湖北省重点实验室,武汉430022

出　　处：《肿瘤研究与临床》2022年第3期166-170,共5页Cancer Research and Clinic

摘　　要：目的探讨^(99)Tcm硫胶体淋巴显像在妇科肿瘤术后下肢淋巴水肿诊断中的意义。方法回顾性分析2015年5月至2019年10月就诊于华中科技大学同济医学院附属协和医院的妇科肿瘤术后下肢淋巴水肿患者的临床资料。患者均进行^(99)Tcm硫胶体淋巴显像,分析淋巴管显像、淋巴结显像以及二者联合诊断下肢淋巴水肿的结果,并通过受试者工作特征(ROC)曲线及曲线下面积(AUC)评估淋巴管显像和淋巴结显像单独及二者联合的诊断效能,计算约登指数、灵敏度和特异度。结果50例患者的100个下肢中发生淋巴水肿56个,无明显水肿44个。单独以淋巴管显像异常进行诊断,56个淋巴水肿下肢中,下肢淋巴管显像阳性38个(67.9%),阴性18个(32.1%);44个无明显水肿下肢中,下肢淋巴管显像阳性6个(13.6%),阴性38个(86.4%);灵敏度67.9%,特异度86.4%,约登指数0.543。单独以淋巴结显像异常进行诊断,56个淋巴水肿下肢中,下肢淋巴结显像阳性42个(75.0%),阴性14个(25.0%);44个无明显水肿下肢中,下肢淋巴结显像阳性13个(29.5%),阴性31个(70.5%);灵敏度75.0%,特异度70.5%,约登指数0.455。以淋巴管显像与淋巴结显像联合诊断,56个淋巴水肿下肢中,淋巴管与淋巴结显像阳性48个(85.7%),阴性8个(14.3%);44个无明显水肿下肢中,淋巴管与淋巴结显像阳性14个(31.8%),阴性30个(68.2%);灵敏度85.7%,特异度68.2%,约登指数0.539。淋巴管显像与淋巴结显像联合诊断的AUC为0.781,淋巴管显像异常诊断AUC为0.771,淋巴结显像异常诊断AUC为0.739(均P<0.01)。结论^(99)Tcm硫胶体淋巴显像对妇科肿瘤术后下肢淋巴水肿的诊断有较大帮助。淋巴结显像与淋巴管显像联合对患者下肢淋巴水肿的诊断效能较高。Objective To explore the significance of^(99)Tcm-sulfur colloid lymphoscintigraphy in the diagnosis of lower limb lymphedema after gynecological tumor surgery.Methods The clinical data of patients with lower limb lymphedema after gynecological tumor surgery in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from May 2015 to October 2019 were retrospectively analyzed.^(99)Tcm-sulfur colloid lymphoscintigraphy was performed in all patients.The results of lymphatic vessel imaging,lymph node imaging and their combination in the diagnosis of lower limb lymphedema were analyzed.The diagnostic efficacy of lymphatic vessel imaging alone,lymph node imaging alone and their combination was evaluated by the receiver operating characteristic(ROC)curve and the area under the curve(AUC),and the Youden index,sensitivity and specificity were calculated.Results Among the 100 lower limbs of 50 patients,56 limbs had lymphedema and 44 limbs had no obvious edema.When diagnosis was based on abnormal lymphatic vessel imaging alone,among 56 lower limbs with lymphedema,lower limbs lymphatic vessel imaging was positive in 38(67.9%)and negative in 18(32.1%);among 44 lower limbs without obvious edema,lower limbs lymphatic vessel imaging was positive in 6(13.6%)and negative in 38(86.4%);the sensitivity was 67.9%,the specificity was 86.4%,and the Youden index was 0.543.When diagnosis was based on abnormal lymph node imaging alone,among 56 lower limbs with lymphedema,lower limbs lymph node imaging was positive in 42(75.0%)and negative in 14(25.0%);among 44 lower limbs without obvious edema,lower limbs lymph node imaging was positive in 13(29.5%)and negative in 31(70.5%);the sensitivity was 75.0%,the specificity was 70.5%,and the Youden index was 0.455.When diagnosis was based on the combination of lymphatic vessel imaging and lymph node imaging,among 56 lower limbs with lymphedema,lymphatic vessel imaging and lymph node imaging were positive in 48(85.7%)and negative in 8(14.3%);among 44 lower

关 键 词：生殖器肿瘤 女(雌)性 99m锝硫胶 淋巴水肿 诊断 

分 类 号：R737.3[医药卫生—肿瘤]