^18F-FDG PET／CT在宫颈癌诊断中的应用

Application of ^18F-FDG PET/CT for the diagnosis of cervical cancer

目的探讨^18F-脱氧葡萄糖（FDG）PET／CT在宫颈癌诊断及其复发、转移灶探测中的应用价值。方法88例患者行腹部或全身^18F-FDGPET／CT显像，其中初诊者30例（宫颈良性病变11例，宫颈癌19例），宫颈癌治疗后58例。病灶根据病理检查、多种影像诊断技术及临床随访确诊，随访时间均为6个月～3年。结果30例初诊者中，PET／CT诊断宫颈癌的灵敏度、特异性和准确性分别为17／19，10／11和27／30（90．0％）。58例治疗后患者中，11例存在肿瘤复发或残余，PET／CT诊断肿瘤复发、残余的灵敏度、特异性和准确性分别为10／11，47／47（100．0％）和57／58（98．3％）。41例有肿瘤转移，PET／CT诊断转移灶的灵敏度、特异性和准确性分别为92．7％，88．9％和90．9％；转移灶以盆腹腔淋巴结为主，39．0％有盆腔淋巴结转移，27．3％有腹膜后淋巴结转移，所有淋巴结转移患者中PET／CT发现26．8％病灶直径〈1．0cm。28．6％（22／77）的患者PET／CT发现腹腔外远处转移灶。18例输尿管梗阻患者中，16例PET／CT发现为肿瘤侵犯压迫所致。结论^18F—FDG PET／CT显像在宫颈癌的诊断及其复发、转移灶探测中有良好的应用价值，尤其是对远处转移灶和小淋巴结转移灶的检测，可使临床分期更准确。

Objective The purpose of this study was to evaluate the clinical value of ^18F-fluorodeoxyglucose （FDG） PET/CT for staging and retaging cervical cancer cases. Methods This retrospective study included 88 patients. Of the 88 patients, 19 were primary cervical cancer, 11 were benign cervical tumor and 58 were cervical cancer patients with post-treatment surveillance. All had either whole body or abdominal-pelvic FDG PET/CT imaging. The diagnosis was established according to the pathologic results of surgery or biopsy, and（or） multi-modality imaging and clinical follow-up for at least six months. Results For initial diagnosis of cervical cancer, the sensitivity, specificity and accuracy of FDG PET/CT were 17/19 （89.5%）, 10/11 （90.9%） and 27/30（90.0% ） respectively. For re-staging cervical cancer, the sensitivity, specificity and accuracy of FDG PET/CT were 10/11 （90. 9% ）, 47/47 （ 100. 0% ） and 57/58 （98. 3% ） respectively. In all, 41 had metastases. The sensitivity, specificity and accuracy of FDG PET/ CT detecting metastases were 92.7%, 88.9% and 90.9% respectively. Of the metastatic sites, 66.3% were abdominal-pelvic lymph nodes,26.8% of the metastatic lymph nodes were detected with diameters less than 1.0 cm. Twenty-two of twenty seven （28.6%） patients were identified to have extra-pelvic lesions after PET/CT and were then changed their treatment plans. Conclusions ^18F-FDG PET/CT is useful in staging and re-staging cervical cancer patients. PET/CT is of great value in identifying small lesions and also in detecting extra-pelvic lesions.