^18F-FDGPET/CT在原发性乳腺癌治疗后随访期间血清CEA和(或)CA153升高患者中的应用

Application of ^(18)F-FDG PET/CT in Follow-up of Primary Breast Cancer Patients with Increased Serum CEA and(or) CA153

目的通过对56例乳腺癌治疗后CEA和(或)CA153升高病例的回顾性分析,了解18F-FDG PET/CT此类患者复发转移诊断方面的临床应用价值。方法发现血清CEA和(或)CA153升高后3天至1月内行常规18F-FDG PET/CT显像。由三名有多年诊断经验的医师独立阅片,有两名及以上医师意见一致时方可做出诊断。以病理结果或随访一年结果作为诊断金标准。结果 56例患者确诊局部复发2例、转移30例、无复发转移14例、第二原发癌10例。18F-FDG PET/CT显像阳性者41例(假阳性1例)、阴性者15例(假阴性病例2例)。其诊断敏感度95.24%,特异性92.86%,准确性94.64%,假阴性率4.76%,假阳性率7.14%,PPV 97.56%,NPV 86.67%。单纯CEA升高、单纯CA153升高及二者联合升高诊断阳性预测值(PPV)分别为:57.14%、90.91%和94.12%,其差异有统计学意义(χ2=10.430,P=0.005)。结论乳腺癌治疗后随访期间出现CEA和(或)CA153升高的患者,18F-FDG PET/CT显像可以准确识别或排除复发转移,还可以发现第二原发癌,具有较高的诊断效能和较好的临床应用价值。

Objective To understand the application value of 18F-FDG PET/CT in the diagnosis of recurrence and metastasis of breast cancer patients with increased serum CEA and/or CA153 after treatment. Methods 18F-FDG PET/CT images of 56 breast cancer patients who underwent surgery with or without chemotherapy or radiotherapy were acquired in three days to one month after increased serum CEA and（or） CA153 were found. Diagnoses were made by the consistent comment of two or more doctors after three experienced nuclear medicine doctors reviewed the images retrospectively and independently. And the gold standard of diagnoses were the results of either pathology or one-year follow-up. Results Of all 56 cases, there were two cases of local recurrence, 30 cases of metastasis, 14 cases without recurrence and 10 cases of second primary tumor. 18F-FDG PET/CT imaging was positive in 41 cases（one false positive case）, negative in 15 cases（two false negative cases）. The diagnostic efficiency of 18F-FDG PET/CT were： sensitivity 95.24%, specificity 92.86%, accuracy 94.64%, false negative rate 4.76%, false positive rate 7.14%, positive predictive value（PPV） 97.56%, and negative predictive value（NPV） 86.67%. The PPV of increased CEA alone, increased CA153 alone and their combination were 57.14%, 90.91% and 94.12%, respectively（χ2=10.430, P=0.005）. Conclusion 18F-FDG PET/CT can be used to identify or rule out the recurrence and metastasis in breast cancer patients with increased serum CA153 and（or） CEA after treatment, with high diagnostic efficiency and good clinical application value. And it can also suggest the second primary tumor.