^(18)F-氟脱氧葡萄糖PET/CT与鳞状细胞癌抗原在宫颈鳞癌治疗后随访中的应用价值

Value of ^(18)F-FDG PET / CT and SCC Antigen in the Detection of Cervical Cancer after Treatment

目的探讨^(18)F-氟脱氧葡萄糖(^(18)F-FDG)PET/CT及鳞状细胞癌(SCC)抗原诊断宫颈鳞癌初步治疗后是否存在残余、复发或转移的价值。方法回顾性分析2008年1月—2014年4月河北医科大学第四医院155例宫颈鳞癌患者资料,所有患者治疗后随访中怀疑出现残余、复发或转移并进行了^(18)F-FDG PET/CT检查和血清SCC抗原测定,以病理及随访结果为诊断标准,计算^(18)F-FDG PET/CT、SCC抗原及联合指标在宫颈鳞癌治疗后随访中的诊断效能。结果 155例患者经病理及随访证实存在残余、复发或转移128例,无恶性病变存在27例。^(18)F-FDG PET/CT正确诊断150例,诊断灵敏度为99.2%,特异度为85.2%,正确率为96.8%,阳性预测值为96.9%,阴性预测值为95.8%。SCC抗原正确诊断122例,诊断灵敏度为80.5%,特异度为70.4%,正确率为78.7%,阳性预测值为92.8%,阴性预测值为43.2%。4例^(18)F-FDG PET/CT假阳性患者中3例SCC抗原阴性。1例^(18)F-FDG PET/CT假阴性患者中SCC抗原阳性。8例SCC抗原假阳性患者中7例^(18)F-FDG PET/CT阴性,25例SCC抗原假阴性患者均^(18)F-FDG PET/CT阳性。联合指标正确诊断144例,诊断灵敏度为100.0%,特异度为59.3%,正确率为92.9%,阳性预测值为92.1%,阴性预测值为100.0%。^(18)F-FDG PET/CT、SCC抗原及联合指标诊断宫颈癌治疗后存在残余、复发或转移的ROC曲线下面积分别为0.918〔95%CI(0.838,0.998)〕、0.754〔95%CI(0.646,0.862)〕、0.796〔95%CI(0.678,0.914)〕。结论^(18)F-FDG PET/CT辅以血清SCC抗原在宫颈鳞癌治疗后评估是否存在残余、复发或转移中具有良好的诊断效能,具有重要应用价值。

Objective To assess the value of（18）F- FDG PET / CT and serum squamous cell carcinoma（ SCC） antigen in the detection of residual,recurrent or metastasis in patients with cervical squamous cancer after treatment. Methods From January 2008 to April 2014,155 patients with cervical squamous cancer suspected residual, recurrent or metastasis after treatment,which had undergone^（18）F- FDG PET / CT scans and SCC antigen measurement in Fourth Hospital of Hebei Medical University were retrospectively analyzed. Diagnostic efficiency of^（18）F- FDG PET / CT and SCC antigen were analyzed according to pathology and follow- up results. Results Of the 155 patients included in this study,128 patients were malignant,while 27 were benign. The overall patient- based sensitivity, specificity, accuracy, positive predictive value（ PPV） and negative predictive value（ NPV） of^（18）F- FDG PET / CT for the detection of malignancy were 99. 2%,85. 2%,96. 8%,96. 9% and95. 8%,while SCC antigen were 80. 5%,70. 4%,78. 7%,92. 8% and 43. 2%, respectively. All the 4 false- positive^（18）F- FDG PET / CT results were associated with negative SCC antigen except one,and 1 false- negative PET / CT results was positive SCC antigen,8 false- positive SCC antigen were associated with 7 negative on^（18）F- FDG PET / CT,while 25 false-negative SCC antigen were all positive^（18）F- FDG PET / CT results. The sensitivity, specificity, accuracy, PPV and NPV of combination index for the detection of malignancy were 100. 0%,59. 3%,92. 9%,92. 1% and 100. 0%,respectively. The area under ROC curve of^（18）F- FDG PET / CT,SCC antigen and combination index were 0. 918 〔95% CI（ 0. 838,0. 998） 〕,0. 754 〔95% CI（ 0. 646,0. 862） 〕and 0. 796 〔95% CI（ 0. 678,0. 914） 〕. Conclusion^（18）F- FDG PET / CT imaging and Serum SCC antigen, which have important value in cervical squamous cancer, can be complementary method in cases of suspected malignant focus exist after treatment.