^18F-FDG SPECT-CT显像在乳腺癌肿瘤标志物升高患者复发和转移诊断中的价值

The role of ^18F-FDG SPECT-CT in detecting recurrence and metastases in breast cancer patients with elevated tumor markers

目的探讨^18F-FDG SPECT-CT显像对血清肿瘤标志物升高的乳腺癌患者术后复发和转移的诊断价值。方法对35例血清肿瘤标志物升高的乳腺癌术后患者进行^18F-FDG SPECT-CT显像和传统影像学检查（包括胸部、腹部、盆腔部CT和全身骨显像），比较^18F-FDG SPECT-CT显像和传统影像学检查诊断肿瘤复发和转移的敏感度、特异度、准确度、阳性预测值和阴性预测值。结果根据病理检查结果或1年以上的临床随访结果，35例患者中，有19例最终诊断为复发或转移。按病灶计算，^18F-FDG SPECT-CT显像诊断的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为93．1％、55．6％、84．2％、87．1％和71．4％；传统影像学检查诊断的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为80．5％、60．5％、75．6％、80．2％和65．1％。按患者计算，^18F-FDG SPECT-CT显像诊断的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为84．2％、62．5％、74．3％、72．7％和76．9％；传统影像学检查诊断的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为74．1％、67．6％、70．6％、68．3％和73．9％。^18F-FDG SPECT-CT显像诊断的敏感度明显高于传统影像学检查（P〈0．05）。依据^18F-FDG SPECT-CT的显像结果，14例（40．0％）患者改变了治疗方案。结论^18F-FDG SPECT-CT显像对血清肿瘤标志物升高的乳腺癌患者术后复发和转移诊断的敏感度高于传统影像学检查。

Objective To compare retrospectively the role of ^18F-FDG SPECT-CT and conventional imaging in the detection of recurrence and metastases in postoperative breast cancer patients with elevated level of tumor markers, and to evaluate the impact of ISF-FDG SPECT-CT on the management of breast cancer patients. Methods ^18F-FDG SPECT-CT was performed in 35 breast cancer patients with suspected recurrence based on elevated level of serum tumor markers. Chest, abdomen and pelvic CT were performed in all patients and whole-body bone scan was performed in only 21 patients. The final diagnosis of recurrent breast cancer was confirmed by either pathology or observation by imaging during the follow-up for more than 1 year. Results Among the 35 patients, the final diagnosis of recurrence or metastasis was established in 19 patients. Of the 114 sites of increased FDG uptake, 93 were interpreted as malignant and 21 as benign. On site-based analysis, the sensitivity, specificity, accuracy, positive and negative predictive values were 93.1%, 55.6%, 8d.2%, 87.1% and 71.4%, respectively, for ^18F-FDG SPECT-CT, and 80.5%, 60.5%, 75.6%, 80.2% and 65.1%, respectively, for conventional imaging. On the patient-based analysis, the sensitivity, specificity, accuracy, positive and negative predictive values were 84.2%, 62.5%, 74.3%, 72.7% and 76.9%, respectively, for ^18F-FDG SPECT-CT, and 74.1%, 67.6%, 70.6%, 68.3% and 73.9%, respectively, for conventional imaging. The results of ^18F-FDG SPECT-CT led to changes in the subsequent clinical management of 40.0% of these patients. Conclusion In postoperative breast cancer patients with elevated level of tumor markers during the follow-up, lS F-FDG SPECT-CT is more sensitive for detecting recurrence and metastases than conventional imaging.