18氟-氟代脱氧葡萄糖正电子发射计算机断层扫描在肺癌早期诊断中的应用价值

Value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in early diagnosis of lung cancer

目的探讨18氟-氟代脱氧葡萄糖（18F-FDG）正电子发射计算机断层扫描（PET／CT）在肺癌早期诊断中的应用价值。方法对2010年6月至2012年10月复旦大学附属中山医院收治的347例肺部占位性病变进行回顾性研究，分析PET／CT的诊断效度以及病变形态、病理类型、血清肿瘤标志物水平对其诊断效度与病灶FDG最大标准摄取值（SUVmax）的影响，评价PET／CT联合肿瘤标志物检测对肺部占位的早期诊断价值。结果SUVmax 与病灶大小呈正相关（r=0．484，P〈0．05），与肿瘤的分化程度呈负相关（r=-0．232，P〈0．01），且肿瘤标志物阳性者病灶SUVmax 显著高于阴性者（10．6±5．5比7．6±5．4，P〈0．05）；PET／CT 诊断肺癌的特异度、敏感度、准确度分别为50．0％、96．6％、89．3％，且病灶越大，诊断的准确度越高（P〈0．05）；PET／CT联合血清肿瘤标志物检测可使PET／CT诊断肺癌的特异度提高30％左右（P〈0．01）。结论 18F—FDGPET／CT对肺结节的早期诊断有较高的价值，对肺癌的分化程度也有-定的提示作用，联合血清肿瘤标志物检测可提高肺癌早期诊断的特异度。

Objective To evaluate the application value of 18F-fluorodeoxyglucose （18 F-FDG） positron emission tomography/computed tomography （PET/CT） in early diagnosis of lung cancer. Methods Retrospective analyses were conducted for 347 cases of pulmonary space-occupying lesions at Zhongshan Hospital from June 2010 to October 2012. The diagnostic validity of PET/CT and fluorodeoxyglueose maximum standardized uptake value （SUVmax ） of lesions were compared respectively. Among different morphological characteristics, pathologic types and levels of tumor markers. The diagnostic value of PET/CT was also evaluated along with serum tumor markers for lung cancer. Results SUVmax was positively correlated with lesion size （ r = 0. 484, P 〈 0. 05 ） and negatively with tumor differentiation degree （ r = -0. 232, P 〈 0. 01 ）. It was significantly higher in tumor marker positive group than the negative group （ 10. 6 ±5.5 vs 7.6 ± 5.4, P 〈 0. 05 ）. The diagnostic specificity, sensitivity and accuracy of PET/CT were 50. 0%, 96. 6% and 89. 3% in lung cancer. And the greater the lesion, the higher the diagnostic accuracy （P 〈 0. 05 ）. PET/CT plus serum tumor markers could boost the diagnostic specificity of lung cancer by 30% （P 〈 0. 01 ）. Conclusions is F-FDG PET/CT has high diagnostic values for early stage pulmonary nodules. It can also suggest the differentiation degree of lung cancer. Combined use of serum tumor markers and 18F-FDG PET/CT increases the early diagnostic specificity of lung cancer.