99Tcm-3PRGD2整合素受体显像在乳腺癌定性诊断中的价值及与钼靶检查的对比研究

Evaluation of 99Tcm-3PRGD2 integrin receptor imaging in qualitative diagnosis of breast cancer and its comparison with mammography

目的 研究99Tcm-联肼尼克酰胺-3聚乙二醇-精氨酸-甘氨酸-天冬氨酸环肽二聚体（99Tcm-3PRGD2）整合素受体显像在乳腺癌定性诊断中的价值及与钼靶检查的对比。方法 选取初诊乳腺占位患者84例，均为女性。所有患者行2 h、4 h 99Tcm-3PRGD2 整合素受体显像及钼靶检查，以术后病理结果作为“金标准”，比较不同显像方法（全身显像及胸部SPECT/CT显像）对乳腺癌定性诊断的价值，并与钼靶结果进行对比分析。采用SPSS22.0软件，对数据进行t检验和χ2检验。结果 SPECT/CT显像的诊断效能高于全身显像；乳腺癌99Tcm-3PRGD2摄取率[病灶容积最大计数（Tmax）、病灶容积平均计数（Tmean）、Tmax/本底平均计数（B）值及Tmean/B值]均明显高于良性占位（t=2.09-3.19，均P〈0.05），且Tmax/B值差异更为明显（t=3.19，P〈0.01）；2 h、4 h显像对乳腺癌诊断效能差异无统计学意义（t=0.63~1.25，均P〉0.05）。SPECT/CT显像诊断乳腺癌的灵敏度大于95.0%，联用钼靶后灵敏度可以提高到98.4%；对致密型乳腺患者，SPECT/CT显像与钼靶诊断乳腺癌的灵敏度、特异度、准确率分别为95.2%、83.3%、91.7%和78.6%、76.2%、77.8%，前者的准确率高于后者，且差异有统计学意义（χ2=4.341，P〈0.05）。结论 99Tcm-3PRGD2 SPECT/CT显像定性诊断乳腺癌具有高灵敏度，是对钼靶的有益补充，尤其对致密型乳腺占位患者具有独特优势。

Objective To evaluate the value of 99Tcm-3PRGD2 integrin receptor imaging in qualitative diagnosis of breast cancer and then compare this technique with mammography. Methods A total of 84 female patients with established breast lesions were recruited. All patients were examined using 99Tcm-3PRGD2 integrin receptor imaging and mammography. Diagnosis of breast（especially dense breast） lesion by using these two techniques was analyzed and compared with postoperative pathology as the gold standard. T test and χ2 test were used for data statistical analysis by using SPSS22.0 software. Results The diagnostic efficiency of SPECT/CT imaging was higher than that of whole-body imaging. The intake rates of Tmax, Tmean, Tmean/B, and Tmax/B were significantly higher in breast cancer than in benign nodules（t=2.09~3.19, all P〈0.05）, and their difference in intake of Tmax/B was obvious（t=3.19, P〈0.01）. The difference between 2 and 4 h imaging was not significant（t=0.63~1.25, all P〉0.05）. The sensitivity of SPECT/CT in diagnosis of breast cancer was more than 95.0%, which could be increased to 98.4% when this technique was combined with mammography. For dense mammary gland, the sensitivity, specificity, and accuracy of 99Tcm-3PRGD2 SPECT/CT and mammography were 95.2%, 83.3%, and 91.7% and 78.6%, 76.2%, and 77.8%, respectively, 99Tcm-3PRGD2 SPECT/CT had a higher accuracy（χ2=4.341, P〈0.05）. Conclusions 99Tcm-3PRGD2 SPECT/CT had high sensitivity and was a useful complement to mammography. This technique demonstrated a higher diagnostic value than mammography for qualitative diagnosis of dense mammary gland.