^18F—FDG符合线路显像与肿瘤标志物检测对复发性子宫内膜癌的诊断价值

Value of ISF-FDG imaging and serum tumor markers in the diagnosis of recurrent endometrial carcinoma

目的比较^18F—FDG符合线路显像与血清肿瘤标志物检测在复发性子宫内膜癌诊断中的临床价值，以及^18F-FDG显像与肿瘤标志物之间的关系。方法对35例疑有复发的子宫内膜癌患者以GE—Millennium VG with Hawkeye成像仪进行^18F—FDG符合线路显像，并采用酶联免疫分析法进行血清卵巢癌相关抗原CA-125和CP-2测定。^18F—FDG显像以扫描野内出现异常代谢增高灶作为肿瘤复发的诊断依据，而血清CA-125和CP-2均以≥35U／ml作为肿瘤复发的阳性指标。结果35例患者中，肿瘤复发13例。血清CA-125对复发性子宫内膜癌诊断的灵敏度、特异度和准确性分别为53．8％、100％和82．9％，血清CP-2分别为38．5％、81．0％和65．7％，^18F—FDG显像分别为100％、90．9％和94．4％。血清CA-125与^18F—FDG显像结果之间的符合率为77．1％（Kappa=0．50，P：0．001），且^18F—FDG显像中复发肿瘤总体积与血清CA-125水平呈正相关（r=0．89，P〈0．001），但肿瘤对FDG的摄取程度与血清CA-125水平之间未见明显相关性。结论以血清肿瘤标志物检测诊断复发性子宫内膜癌时，CA-125优于CP-2；而^18F—FDG显像对复发性子宫内膜癌的诊断优于CA-125，且检出病灶总体积与CA-125水平呈正相关。

Objective Both ^18F-fluorodeoxyglucose （ FDG ） imaging and serum tumor marker measurements can be used in the post-therapy surveillance of recurrent endometrial carcinoma, but the relationship between those two methods has not been demonstrated yet. The purpose of this study was to compare the diagnostic efficiency of ^18F-FDG imaging and serum tumor marker measurements in the diagnosis of recurrent endometrial carcinoma, as well as to analyze the correlation between those two methods. Methods Thirty-five patients with histopathologically confirmed endometrial carcinoma and suspected to have recurrent disease during post-therapy surveillance were included in this study. ^18F-FDG images from the thorax to the pelvis were obtained in all patients by using GE-Millennium VG Hawkeye system, and the abnormal FDG uptake was judged as tumor recurrence. Serum CA-125 and CP-2 were also measured for each patient by enzyme-linked immunoassay, and a cutoff value of 35 U/ml was taken as the criteria for predicting tumor recurrence. Based on the final clinical diagnosis, the efficiency of tumor markers （CA-125, CP-2） and ISF-FDG imaging in the diagnosis of recurrent tumor was evaluated. Results According to the histopathological diagnosis or follow-up examinations, tumor recurrence was confirmed in 13 of the 35 patients. Elevated serum level of CA-125 was found in 7 patients, serum CP-2 was increased in 9, and JSF- FDG imaging was positive in 15. The diagnostic sensitivity, specificity and accuracy were 53.8% , 100% and 82.9% for the serum CA-125; 38.5%, 81.0% and 65.7% for the serum CP-2, and 100%, 90.9% and 94.3% for the ^18F-FDG imaging, respectively. The diagnostic coincidence rate between the ISF-FDG imaging and serum CA-125 was 77. 1% （Kappa = 0 found between the ^18F-FDG imaging and serum CP-2. 50, P = 0.001 ）, but no significant correlation was In the patients with true positive ^18F-FDG imaging, a positive correlation between the tumor volume and the serum CA-125 value was found （ r = 0. 89, P 〈0.001 ）, but no correlation was found between the tumor uptake and the serum CA-125 values. Conclusion For the post-therapy surveillance of patients with endometrial carcinoma, serum CA-125 is a high specific tumor marker for diagnosing recurrent disease and better than CP-2, but ^18F-FDG imaging is better than CA- 125, and there is a positive correlation between tumor volume and serum CA-125 value.