^(18)F-氟代脱氧葡萄糖正电子放射导向手术在结直肠癌治疗中的初步应用

The preliminary study using ^(18)F-fluorodeoxyglucose positron-radioguided surgery for colorectal carcinoma operation

目的报告18F-氟代脱氧葡萄糖(18F-FDG)应用于结直肠癌放射导向手术的方法和临床应用价值。方法术前2h将18F-FDG111MBq静脉注射入结直肠癌患者体内,开腹后以γ探测仪探测肿瘤原发部位(T)及正常组织(NT),每隔1h测定一次,至手术开始后5h;对离体标本的上下两个断端及癌旁组织进行测定、对标本的各组系膜淋巴结进行测定,探索正电子放射导向手术(PRGS)的最佳术中探测时间。以T/NT≥1.5为阳性标准,计算PRGS对原发肿瘤的探测敏感性和特异性、对系膜淋巴结转移的敏感性及特异性。结果PRGS的最佳术中探测时间为静脉给药后的第5到第6小时。PRGS对原发肿瘤的灵敏度为100%,特异度为71.9%;对淋巴结转移的灵敏度及特异度分别为83.3%和68.9%。结论18F-FDGPRGS对结直肠癌的诊断、浸润范围和淋巴结转移的判断具有较高敏感性和特异性,对结直肠癌肿瘤切除范围和淋巴结清扫范围有一定的指导意义。

Objective To report the method and the value of positron nuclide-^18F-fluorodeoxygtucose （^18F-FDG） in radioguided surgery （RGS） in colorectal carcinoma. Methods Intravenously injected 111MBq ^18F-FDG into 8 patients with colorectal carcinoma 2 hours before the operation. The detections were processed every hour and lasted five hours from the very. beginning of the operations. We detected targets of tumors （T） and normal tissue （NT） by using a portable gamma-detecting probe. Additionally, we detected the proximal and distal edge of excised specimens, the tissue of colon wall 2cm to upper and lower edges of primary tumors of specimens, the lymph nodes of specimens. We were able to find the optimal time for posiron radioguidocl surgery （ PRGS ）. Choosing the positive criterion T/NT ≥ 1.5, We were able to calculate the sensitivity of PRGS of the primary tumor, the specificity of colon wall tissue and excised edge, the sensitivity and specificity of lymph nodes. Results The optimal time for PRGS is the 5th-6th hour after intravenous injection of the ^18F-FDG. The sensitivity of primary tumor detection is 100%. The specificity of colon wall tissue and excised edge is 71.9%. The sensitivity and specificity of lymph nodes detections are 83.3% and 68.9%. Conclusion PRGS had high sensitivity and specificity in judging the infiltrating range and lymph nodes metastasis in colorectal carcinoma.