^(18)F-FDG PET/CT在原发乳腺癌患者治疗后随访中的应用

Application of ^(18)F-FDG PET/CT in follow-up of primary breast cancer patients after treatment

目的探讨^(18)F-FDG PET/CT显像在原发乳腺癌治疗后随访中的作用。方法收集原发乳腺癌治疗后患者174例,均接受^(18)F-FDG PET/CT检查,由3名有多年诊断经验的医师独立阅片,以病理结果或随访1年结果为诊断标准。结果 174例患者中确诊复发转移72例,无复发转移64例,第二原发癌38例。18 F-FDG PET/CT显像阳性者116例(复发转移69例、第二原发癌38例、假阳性9例),显像阴性者58例(无复发转移55例,假阴性病例3例)。18 F-FDG PET/CT显像与血清肿瘤标志物的诊断效能分别为:灵敏度97.91%vs 72.73%,特异度85.94%vs 57.81%,准确率93.10%vs67.24%,假阴性率2.73%vs 27.27%,假阳性率14.06%vs 42.19%,阳性预测值92.24%vs 74.77%,阴性预测值94.83%vs 55.22%,两者联合有助于提高阳性预测值和阴性预测值。患者的年龄、临床分期、治疗方法、18 F-FDG PET/CT显像结果和血清肿瘤标志物情况是其病理/随访结果的影响因素(P<0.05),而患者的性别、原发病变部位、ER、PR、Her2的表达情况不是其病理/随访结果的影响因素(P>0.05)。结论 ^(18)F-FDG PET/CT显像可以较为准确地诊断或排除乳腺癌治疗后复发转移,还可帮助发现第二原发癌,具有较好的临床应用价值。

Objective To explore the value of ^（18）F-FDG PET/CT in diagnosis of recurrence and metastasis in the followup of primary breast cancer patients.Methods ^（18）F-FDG PET/CT images of 174 breast cancer patients who underwent surgery with or without chemotherapy or radiotherapy were retrospectively reviewed.Diagnoses were made by three experienced nuclear medicine doctors and the diagnostic standard was the results of either pathology or one year follow-up.Results Of all 174 cases,there were 72 cases of local recurrence or metastasis,64 cases without recurrence and 38 cases of second primary tumor cases.^（18）F-FDG PET/CT imaging was positive in 116cases（69cases of recurrence or metastasis,38 cases of second primary tumor and 9false positive cases）,negative in 58cases（55cases with no recurrence and metastasis,3false negative cases）.The diagnostic efficiency of ^（18）F-FDG PET/CT and serum tumor maker were 97.91% vs 72.73%in sensitivity,85.94% vs 57.81%in specificity,93.10% vs 67.24%in accuracy,2.73% vs 27.27%in false negative rate,14.06% vs 42.19%in false positive rate,92.24% vs 74.77%in positive predictive value（PPV）,and 94.83% vs 55.22%in negative predictive value（NPV）.The combination of these two methods could improve PPV and NPV.Age,clinical stage,treatment method,^（18）F-FDG PET/CT and serum tumor maker were predictors of follow-up results（P〉0.05）,while gender,primary tumor site,ER,PR,Her2 were not（P〈0.05）.Conclusion 18 F-FDG PET/CT can be used to identify/rule out recurrence and metastasis or suggest second primary tumor in the follow up of breast cancer patients.