^(18)F-FDG PET/CT对乳腺癌术后复发转移的诊断价值

Value of fluorine-18 fluorodeoxyglucose positron emission tomography/CT to the diagnosis of recurrent and metastatic breast cancer

目的探讨18F-脱氧葡萄糖(fluorine-18fluorodeoxyglucose,18F-FDG)正电子发射体层摄影术(positron emission tomography/CT,PET/CT)在乳腺癌术后复发转移中的诊断价值及其与糖链抗原(carbohydrate antigen,CA)15-3的关系。方法乳腺癌术后疑诊复发转移患者48例,均行18 F-FDG PET/CT全身显像检查,与组织病理或临床随访结果进行对照,计算18F-FDG PET/CT诊断复发转移的特异性、敏感性;检测48例患者CA15-3水平,并依据检测结果分为增高组(CA15-3≥25μg/L)26例和正常组(CA15-3<25μg/L)22例,比较2组18 F-FDG PET/CT复发转移检出率。结果组织病理或临床随访证实复发转移34例;18F-FDG PET/CT发现阳性病灶35例(其中假阳性2例),未发现异常代谢增高灶13例(其中假阴性1例),诊断乳腺癌术后复发转移的敏感性为97.1%,特异性为85.7%,准确性为93.8%,阳性预测值为94.3%,阴性预测值为92.3%;增高组18F-FDG PET/CT复发转移检出率为76.9%,正常组为59.1%,2组比较差异无统计学意义(P>0.05)。结论 18F-FDG PET/CT在乳腺癌术后复发转移诊断中有重要价值,并适用于CA15-3水平正常者。

Objective To evaluate the value of fluorine-18 fluorodeoxyglucose （^18F-FDG） positron emission tomography （PET）/CT to the diagnosis of recurrent and metastatic breast cancer, and to analyze its relationship with carbohydrate antigen 15-3 （CA15-3） level. Methods Forty-eight cases of suspected recurrent and metastatic breast cancer after operation received 18F-FDG PET/CT, and were compared with the histopathologic results or clinical follow-up. The specificity and sensitivity of ^18 F-FDG PET/CT were calculated. The patients were divided into two groups according to CA15-3 level, elevated group （CA15-3 ≥25 μg/L, n=26） and normal group （CA15-3〈25μg/L, n=22）. The detection rates of tumor recurrence or metastasis were compared between two groups. Results Thirty-four cases were confirmed recurrence or metastasis by histopathologic results or clinical follow-up. ^18 F-FDG PET/CT showed positive loci in 35 cases including 2 Cases of false positive loci, and no abnormal hypermetabolie foci in 13 cases including false negative focus in 1 case. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the ^18 F-FDG PET/CT for recurrence and metastasis were 97.1%, 85.7%, 93.8%, 94.3% and 92.3%, respectively. There was no significant difference in the detection rate between elevated group （76.9%） and normal group （59.1%） （P〉 0.05）. Conclusion ^18F-FDG PET/CT has a great value to the diagnosis of recurrent or metastatic breast cancer, even for those with normal CA15-3 level.