应用18F-FDG hPET/CT全身显像诊断颈部淋巴结转移癌的临床效果

目的 探讨颈部淋巴结转移癌患者采用18F-FDG?hPET/CT全身显像的诊断效果及其T/N比值与VEGF、PDGF和MVD的相关性.方法 选择2016年1月至2018年2月颈部淋巴结转移患者39例,入院后患者先行常规影像学检查,然后对患者行18F-FDG?hPET/CT全身显像检查,测定患者T/N比值,计算18F-FDG?hPET/CT全身显像与常规影像学诊断灵敏度、特异度、阳性预测值(PPV)与阴性预测值,分析18F-FDG?hPET/CT全身显像在颈部淋巴结转移癌患者中的诊断效果;颈部淋巴结患者手术后取病理组织、癌旁组织,采用免疫组织化学法测定不同病理组织VEGF、PDGF和MVD的表达阳性情况;分析T/N比值与VEGF、PDGF和MVD的相关性.结果 39例颈部淋巴结转移癌患者中,18F-FDG?hPET/CT全身显像发现25例原发灶,阳性率95%置信区间(47%,79%)为95%,最终经病理检查确诊23例,诊断符合率为92.0%.常规影像学检查出22例(其中真阳16例,假阳6例),两种诊断符合率比较差异有统计学意义(P<0.05);18F-FDG?hPET/CT全身显像用于颈部淋巴结转移癌诊断敏感度、特异度、阳性预测值及阴性预测值,均高于常规影像学(P<0.05);颈部淋巴结转移癌患者病灶组织VEGF、PDGF和MVD阳性率,均高于癌旁组织(P<0.05);SPSS?Pearson相关性分析结果表明,18F-FDG?hPET/CT全身显像T/N比值与VEGF、PDGF和MVD均呈负相关(P<0.05).结论 将18F-FDG?hPET/CT全身显像用于颈部淋巴结转移癌患者中能取得理想的诊断效果,且病理组织中VEGF、PDGF和MVD呈高表达,与T/N比值具有一定相关性,能为临床治疗提供依据和参考.

Objective To investigate the diagnostic value of 18F-FDG hPET/CT and its effect on the expression of VEGF,PDGF and MVD in patients with cervical lymph node metastasis.Methods Thirty-nine patients with cervical lymph node metastasis who were admitted to our hospital from January 2016 to February 2018 were enrolled.After admission,the patients underwent routine radiological examination and then 18 F-FDG hPET/CT whole body imaging examination was performed.T/N ratio,the sensitivity,specificity,positive predictive value(PPV)and negative predictive value of 18F-FDG hPET/CT whole body imaging and routine imaging diagnosis were calculated,and 18F-FDG hPET/CT whole body imaging in cervical lymph node metastasis cancer patients were diagnosed.The pathological and para-cancerous tissues were collected from the patients with cervical lymph nodes.Immunohistochemistry was used to detect the expression of VEGF,PDGF and MVD in different pathological tissues.SPSS Pearson correlation analysis software was used to analyze the T/N ratio and VEGF,PDGF and MVD.Results Totally 25 cases of primary tumor were found by 18F-FDG hPET/CT in 39 patients with cervical lymph node metastasis.The positive rate of 95%confidence interval(95%)was 95%(47%,79%),and finally confirmed by pathological examination 23 cases,the diagnostic coincidence rate was 92.0%.There were 22 cases(18 of them were true-yang,6 were false-yang)by routine imaging.The coincidence rates of the two methods were statistically significant(P<0.05);18F-FDG hPET/CT whole body scintigraphy was used for cervical lymph node the sensitivity,specificity,positive predictive value and negative predictive value of the diagnosis of metastatic carcinoma were higher than those of conventional imaging(P<0.05).The positive rates of VEGF,PDGF and MVD in focal tissue of patients with cervical lymph node metastasis were significantly higher than those in adjacent(P<0.05).SPSS Pearson correlation analysis showed that T/N ratio of 18F-FDG hPET/CT was negatively correlated with VEGF,PDGF and MVD(P<0.05).Conclusion 18F-FDG hPET/CT whole body scintigraphy can be used to diagnose patients with cervical lymph node metastasis,and the expression of VEGF,PDGF and MVD in pathological tissues is highly correlated with T/N ratio,can provide the basis and reference for clinical treatment.