摘要
目的本文通过分析应用18氟-氟代脱氧葡萄糖的正电子发射断层显像/电子计算机断层显像检查(18FDG PET-CT)诊断子宫内膜癌患者盆腔淋巴结转移的情况,探讨其临床应用价值。方法回顾性分析2015年1月至2017年6月在本院就诊且病理确诊的30例子宫内膜癌患者的病例资料,分析患者术前PET-CT图像,以病理结果为"金标准",分析PET-CT检测判断盆腔淋巴结转移的灵敏度、特异度、阳性预测值、阴性预测值及准确度;分析PET-CT原发灶最大标准化摄取值(SUVmax)、淋巴结最大标准化摄取值(LN-SUVmax)对盆腔淋巴结转移的诊断效能。结果基于患者分析,PET-CT在诊断子宫内膜癌盆腔淋巴结转移的灵敏度、特异度、阳性预测值、阴性预测值、准确度分别为:75. 0%、88. 5%、50. 0%、95. 8%、86. 7%;基于盆腔淋巴结区域分析,PET-CT相应数值分别为:83. 3%、98. 3%、55. 0%、99. 6%、98. 3%。当SUVmax> 8时,ROC曲线下面积(AUC)为0. 64,约登指数为0. 42;当LN-SUVmax> 3时,AUC为0. 79,约登指数为0. 63,诊断淋巴结转移的灵敏度、特异度分别为100%、42. 31%,75. 0%、88. 5%,但差异无统计学意义(P> 0. 05)。LN-SUVmax对盆腔淋巴结转移的诊断效能高于原发灶SUVmax,但差异无统计学意义(P> 0. 05)。结论 PET-CT检查对判断淋巴结转移有较高的特异度、阴性预测值,这可为子宫内膜癌患者避免淋巴结切除提供术前依据,从而减少早期子宫内膜癌患者手术风险,改善术后生活质量。原发灶及淋巴结SUVmax尚无确切阈值可准确判断淋巴结转移,有待多中心、大样本临床研究进一步明确PET-CT各参数在判断淋巴结转移的诊断效能。
Objective This study was conducted to assess the accuracy of [^18 F]fluorodeoxyglucose-positron emission tomography/computed tomography (ISFDG PET-CT).in detection of pelvic nodal metastases in endometrial cancer.Methods Patients with endometrial cancer from January 2015 to June 2017 confirmed by the postoperative pathology were retrospectively analyzed.30 patients finished PET-CT before operation.The findings on histopathology were compared with ^18FDG-PET/CT findings to calculate the sen- sitivity,specificity,positive predictive value (PPV),negative predictive value (NPV),and accuracy of ^18FDG-PET/CT.To analyze the efficacy of maximum standardized uptake (SUVmax)and lymph node maximum standardized uptake (LN-SUVmax)of PET-CT in the diagnosis of pelvic lymph node metastasis.Results For detection of pelvic nodes,based on patient analysis,^18FDG-PET/CT had a sensitivity of 75.0%,specificity of 88.5%,PPV of 50.0%,NPV of 95.8%and accuracy of 86.7%.Based on a nodal region analysis,^18FDG-PET/CT had a sensitivity of 83.3%,specificity of 98.3%,PPV of 55.0%,NPV of 99.6%,and accuracy of 98.3%.When maximum standardized uptake values (SUVmax)>8,area under curve (AUC)=0.64,Yonden Index =0.42.When maximum standardized uptake values of lymphonodus (LN -SUVmax)>3 (AUC =0.79,Yonden Index =0.63),the sensitivity and specificity of diagnosis of lymph node metastasis were 100%,42.31%,and 75.0%,88.5%,but without statistically significant difference.Although AUC of LN-SUVmax was higher than SUVmax of primary lesion,but the difference was not statistically significant (P >0.05).Conclusions ^18 FDG-PET/CT has high specificity,NPV for detection of pelvic LN metastasis area in endometrial cancer,which can provide preoperative basis for patients with eudometrial cancer to avoid lymph node resection,thereby reducing the risk of early eudometrial cancer surgery and improving the quality of life after surgery.We concluded that,there were no exact cutoffs of SUVmax for the prediction of lymph node metastases,neither primary lesion,nor lymph
作者
黄珊瑜
李小毛
张宇
程木华
唐欣然
Huang Shanyu;Li Xiaomao;Zhang Ya;Cheng Muhua;Tang Xinran(Department of Gynaecology,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630, China;Department of Nuclear Medicine,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)
出处
《中国医师杂志》
CAS
2019年第1期31-35,共5页
Journal of Chinese Physician
基金
广州市科技计划项目(201607010085)~~
