^(18)F-FDG PET/CT在诊断浸润性乳腺癌和淋巴结转移中的价值

^(18)F-FDG PET/CT in diagnosis of invasive breast cancer and lymph node metastasis

目的评估氟-18标记的2-氟-2-脱氧-D-葡萄糖正电子发射断层扫描(18F-FDG PET/CT)在诊断乳腺癌和腋窝淋巴结(ALN)转移中的价值。方法回顾性分析88例浸润性乳腺癌患者病例资料,所有患者均行18F-FDG PET/CT、钼靶X线和超声检查,40例患者行磁共振成像(MRI)检查,将诊断结果与术后病理结果进行比较。结果 88例病理学检查证实浸润性乳腺癌患者中18F-FDG PET/CT检查阳性75例(85%),阴性13例(15%)。18F-FDG PET/CT、钼靶X线、超声检查、钼靶X线结合超声检查和MRI诊断敏感度分别为85%(75/88)、85%(75/88)、92%(81/88)、97%(85/88)和95%(38/40)。与钼靶X线、超声检查和MRI比较,18F-FDG PET/CT诊断原发性乳腺癌的敏感度差异无统计学意义(P>0.05),钼靶X线检查结合超声的敏感度高于18F-FDG PET/CT(P<0.05)。18F-FDG PET/CT诊断原发性乳腺癌的敏感度与肿瘤分期和大小相关(P<0.05)。以最大标准摄取值(SUVmax)1.5为阳性判断标准,18F-FDG PET/CT诊断乳腺癌ALN转移的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为34.1%(8/21)、84%(56/67)、72%(64/88)、42%(8/19)和81%(56/69),假阴性和假阳性率分别为19%(13/69)和57%(11/19)。结论 18F-FDG PET/CT诊断乳腺癌敏感度并不优于钼靶X线、超声和MRI检查,在乳腺癌ALN转移诊断中的价值有限。钼靶X线结合超声检查敏感度高,是诊断乳腺癌的首选方法。

Objective To evaluate the value of fluorine-18-labeled 2-fluoro-2-deoxy-D-glucose positron emission tomography（18F-FDG PET/CT） in the diagnosis of primary breast cancer and axillary lymph node（ALN） metastasis.Methods The clinical data of 88 patients with invasive breast cancer were retrospectively analysed.All patients underwent 18F-FDG PET/CT scanning,mammography and ultrasonography examinations,and 40 patients received magnetic resonance imaging（MRI）.The diagnostic results of 18F-FDG PET/CT were compared with postoperative pathological findings.Results In 88 patients with pathologically confirmed breast cancer,18F-FDG PET/CT was positive in 75（85%） patients and negative in 13（15%） patients.The values of sensitivity of 18F-FDG PET/CT,mammography,ultrasonography,mammography combined with ultrasonography,and MRI were 85%（75/88）,85%（75/88）,92%（81/88）,97%（85/88） and 95%（38/40） respectively.The sensitivity of mammography combined with ultrasonography was significantly higher than that of 18F-FDG PET/CT（P〈0.05）,while there was no significant difference between 18F-FDG PET/CT and mammography,ultrasonography and MRI（P〉0.05）.The sensitivity of 18F-FDG PET/CT in diagnosis of primary breast cancer was significantly related to tumor staging and size（P〈0.05）.With maximum standard uptake value（SUVmax） cutoff at 1.5,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of 18F-FDG PET/CT in diagnosis of ALN metastasis were 34.1%（8/21）,84%（56/67）,72%（64/88）,42%（8/19） and 81%（56/69） respectively,and the false negative rate and false positive rate were 19%（13/69） and 57%（11/19） respectively.Conclusion 18F-FDG PET/CT is not superior to mammography,ultrasonography and MRI in diagnosis of breast cancer,which has limited value in determination of ALN metastasis.Mammography combined with ultrasonography has higher sensitivity and is the first choice for diagnosis of breast cancer.