F-18FDG-PET对肾细胞癌诊治临床作用初步研究

Clinical role of F-18 fluorodeoxyglucose positron emission tomography for detectionand management of renal cell carcinoma:preliminary experience

目的评价F18FDGPET对肾细胞癌诊断和治疗方案选择的临床作用。方法对怀疑或诊断为原发性肾细胞癌的40例病人进行全身PET检查,确诊依靠病理或随访,比较PET与CT诊断价值并分析PET检查结果对治疗方案选择的影响。结果40例中39例最后诊断为原发性肾细胞癌,PET检查结果真阳性30例,假阴性9例,假阳性1例(为局部肾间质纤维化),而CT真阳性36例;35例常规检查后拟行手术治疗,PET改变治疗方案5例(5/35):1例行肾部切除术;1例因发现双肺多发转移,放弃手术;确诊3例,直接行肾癌根治手术。结论PET对原发性肾细胞癌诊断敏感性不如CT,但对CT等常规影像检查不能确诊的肾细胞癌患者有帮助,能改变约14%术前治疗方案。

Objective To evaluate the clinical role of F-18 fluorodeoxyglucose (FDG)-positron emission tomography (PET)for detection and management of renal cell carcinoma.Methods FDG-PET was performed in 40 patients with suspected or known primary renal tumors and compared with computerized tomography (CT).Histopathological confirmation was obtained in 35 patients and confirmation of the disease was by followup in the remainder.The impact of FDG-PET on disease management was also assessed.Results Of the 40 patients with known or suspected primary tumors FDG-PET was true positive in 30,false-negative in 9 and false-positive in 1.Comparative CT was true positive in 36.35 patients would have undergone operation after conventional imaging findings but FDG-PET results altered treatment decisions for 5(14%),of whom 1 underwent partial nephrectomy and 1 avoided surgery due to detection of unsuspected multiple metastases to the lung parenchyma and 3 were confirmed and performed directly radical nephrectomy.Conclusion The sensitivity of FDG-PET in the detection of RCC is lower than CT,but it may have a complementary role in cases that are equivocal on conventional imaging and altered treatment in 14% preoperatively.