PET/CT与增强CT检测乳腺癌及其腋淋巴结转移的对照研究

The comparison of PET/CT with contrast-enhanced CT in detecting breast cancer and axillary lymph node metastasis

目的探讨18F-脱氧葡萄糖(FDG)PET/CT显像与螺旋CT增强扫描检测乳腺癌及其腋淋巴结转移的临床价值。方法27例乳腺肿块患者于同日行18F-FDGPET/CT显像与CT增强扫描。患者俯卧于乳腺专用泡沫垫上接受检查,前者图像由3位核医学科医师采用目测法结合半定量法进行诊断,后者图像由3位影像科医师分析诊断;最后与病理检查结果对照。结果27例患者PET/CT与增强CT均发现31个乳腺肿块,病理检查证实其中21个为乳腺癌,10个为良性病变;发现腋淋巴结91个,共有66个转移(1例有双侧腋淋巴结转移);PET/CT显像检测乳腺癌原发灶的灵敏度为80.95%,特异性为90%,阳性预测值为94.44%;检测淋巴结转移的灵敏度为89.39%,特异性为88%,阳性预测值为95.16%、增强CT检测乳腺癌原发灶的灵敏度为90.48%,特异性为60%,阳性预测值为82.61%;检测淋巴结转移的灵敏度为86.36%,特异性为52%,阳性预测值为82.6l%。18F-FDGPET/CT和增强CT对腋淋巴结状态的诊断与病理检查结果的列联系数分别为0.64和0.37;两者对乳腺癌及其腋淋巴结转移的诊断特异性差异有显著性(P<0.05);对直径<2cm的病灶,18F-FDGPET/CT诊断准确性明显高于增强CT(P<0.05)。结论18F-FDGPET/CT对诊断乳腺癌及其腋淋巴结转移的特异性均高于增强CT。

Objective To compare the clinical value of ^18F-fluorodeoxyglucose （FDG） PET/CT and contrast-enhanced computed tomography （CECT） in detecting breast tumor and axillary lymph nodes metastasis. Methods 27 patients with primary breast mass were examined with ^18F-FDG PET/CT and CECT at sameday. All the lesions were confirmed histopathologically by surgery or biopsy. ^18F-FDG PET/CT images were analyzed seml-quantitatively and visually by three experienced nuclear medicine doctors and CECT images by three radiologists. The findings of both modalities were compared with pathological results. Results 31 breast tumors and 91 axillary lymph nodes were both find by PET/CT and CECT. Among these lesions, 21 breast cancer and 66 axillary lymph node metastasis were proved by pathology and the others were showed to be benign lesions, One contralateral axillary lymph node metastases was founded in 1 case, PET/CT allowed discrimination between 10 benign and 21 malignant breast masses with a sensitivity of 80. 95%, specificity of 90% and positive predictive value of 94. 44% , but in CECT 90. 48%, 60% and 82.61% respectively, And for the axillary lymph node metastasis, the sensitivity, specificity and positive predictive value of PET/CT were 89. 39%, 88% and 95. 16%, but in CECT 86. 36%, 52% and 82.61% respectively, Findings of both PET/CT and CECT were positively correlated with pathological results on axillary lymph node （Pearson＇ correlation coefficient =0.64 and 0.37 respectively）, The specificity of PET/CT in diagnosis of breast cancer and axillary lymph node metastasis was significantly higher than that of CECT （ P 〈0. 05 ）, The diagnostic accuracy of PET/CT is significantly higher than CECT for the lesions 〈 2 cm in size （ P 〈 0. 05）. Conclusion The specificity and accuracy of PET/CT in diagnosis of breast cancer and axillary lymph node metastasis is significantly higher than CECT, especially for the lesions 〈2 cm in size.